Barriers and facilitators in the implementation of mobilization robots in hospitals from the perspective of clinical experts and developers

Abstract

Background Early mobilization can help reduce severe side effects such as muscle atrophy that occur during hospitalization. However, due to time and staff shortages in intensive and critical care as well as safety risks for patients, it is often difficult to adhere to the recommended therapy time of twenty minutes twice a day. New robotic technologies might be one approach to achieve early mobilization effectively for patients and also relieve users from physical effort. Nevertheless, currently there is a lack of knowledge regarding the factors that are important for integrating of these technologies into complex treatment settings like intensive care units or rehabilitation units. Methods European experts from science, technical development and end-users of robotic systems (n = 13) were interviewed using a semi-structured interview guideline to identify barriers and facilitating factors for the integration of robotic systems into daily clinical practice. They were asked about structural, personnel and environmental factors that had an impact on integration and how they had solved challenges. A latent content analysis was performed regarding the COREQ criteria. Results We found relevant factors regarding the development, introduction, and routine of the robotic system. In this context, costs, process adjustments, a lack of exemptions, and a lack of support from the manufacturers/developers were identified as challenges. Easy handling, joint decision making between the end-users and the decision makers in the hospital, an accurate process design and the joint development of the robotic system of end-users and technical experts were found to be facilitating factors. Conclusion The integration and preparation for the integration of robotic assistance systems into the inpatient setting is a complex intervention that involves many parties. This study provides evidence for hospitals or manufacturers to simplify the planning of integrations for permanent use. Trial registration DRKS-ID: DRKS00023848; registered 10/12/2020.

Robot-Assisted Early Mobilization for Intensive Care Unit Patients: Feasibility and First-Time Clinical Use

“…This differs from other trials in which either nurses or physiotherapists were explicitly assigned to perform the intervention, or the safety of the intervention was tested in feasibility studies (Bertelsen et al, 2020;Gandolfi et al, 2017). To make robot-assisted mobilization an intervention that saves human resources, two other factors should be taken into account: the training of core teams within a unit, indicated in our preliminary research (Warmbein et al, 2023) as well as the need to develop technology that is easy to use in practice, highlighted by Bertelsen et al (2020). However, Brinkmann et al (2022) observed that the implementation of robotic systems for manual patient handling can alleviate physical workload and musculoskeletal strain for nurses.…”

“…For this purpose, a three-year research project was initiated. Prior to that, a comprehensive preliminary study was carried out, which focused on the current state of early mobilization in intensive care units and the experience gained to date with the implementation of robotic systems (Huebner et al, 2022;Klamt et al, 2021;Warmbein et al, 2023;Mehler-Klamt et al, 2022a).…”

Can mobilising specialists be relieved by a robotic system for the early mobilisation of intensive-care patients? A quantitative longitudinal study at three data collection points at a German university hospital

“…In the process of operationalising the phenomena "perception of psychological and physical stress", the standardised observation sheet was initially created. Preparation was based on a previously conducted systematic literature research and evaluation of the preliminary studies performed within the framework of the MobiStaR project (9,11,18) . The relevant variables and their variations were identi ed before designing the observation sheet.…”

“…Moreover, high levels of stress can affect self-esteem and contribute to burnout (8). Robotic systems can be utilised, some of which can even assist or take over mobilisation activities to counteract patients' prolonged immobility and alleviate the workload of the mobilising specialist staff (9). One such robotic system is the adaptive robotic assistance system VEMOTION® developed by ReActive Robotics.…”

Robot-assisted mobilisation in the intensive care unit - does it offer relief to mobilising specialists? A qualitative longitudinal study at three data collection points at a German university hospital

“…1.1.2 Mobilisation with the VEMOTION® robotic system VEMOTION®, an adaptive robotic assistance system, makes it possible to mobilise intensive-care patients in their hospital beds without having to transfer them to a therapy device (14). A robotic system can be docked to an adapted bed in which a patient is secured as shown in Fig.…”