Expectations of Continuous Vital Signs Monitoring for Recognizing Complications After Esophagectomy: Interview Study Among Nurses and Surgeons

Abstract

Background Patients undergoing esophagectomy are at serious risk of developing postoperative complications. To support early recognition of clinical deterioration, wireless sensor technologies that enable continuous vital signs monitoring in a ward setting are emerging. Objective This study explored nurses’ and surgeons’ expectations of the potential effectiveness and impact of continuous wireless vital signs monitoring in patients admitted to the ward after esophagectomy. Methods Semistructured interviews were conducted at 3 esophageal cancer centers in the Netherlands. In each center, 2 nurses and 2 surgeons were interviewed regarding their expectations of continuous vital signs monitoring for early recognition of complications after esophagectomy. Historical data of patient characteristics and clinical outcomes were collected in each center and presented to the local participants to support estimations on clinical outcome. Results The majority of nurses and surgeons expected that continuous vital signs monitoring could contribute to the earlier recognition of deterioration and result in earlier treatment for postoperative complications, although the effective time gain would depend on patient and situational factors. Their expectations regarding the impact of potential earlier diagnosis on clinical outcomes varied. Nevertheless, most caregivers would consider implementing continuous monitoring in the surgical ward to support patient monitoring after esophagectomy. Conclusions Caregivers expected that wireless vital signs monitoring would provide opportunities for early detection of postoperative complications in patients undergoing esophagectomy admitted to the ward and prevent sequelae under certain circumstances. As the technology matures, clinical outcome studies will be necessary to objectify these expectations and further investigate overall effects on patient outcome.

Nurses’ experiences with continuous vital sign monitoring on the general surgical ward: a qualitative study based on the Behaviour Change Wheel

“…Current sensors and vital sign trends still do not include factors such as the nurse worry factor and the critical EWS component 'level of consciousness'. [32][33][34] In line with other studies, the value of the nurse's clinical observations in detection of deterioration was also with respect to reservations about a potential decrease in the bedside nurse-patient contacts by using CMVS which may limit the value of their clinical judgement. 15,35,36 Also, nurses strongly valued the role of the physician in trend assessment because of their expertise with vital sign trends interpretation as part of their clinical judgement.…”

“…Especially, clear criteria to prevent premature transfers of patients from ICU to the general ward with CMVS are needed, which was also was mentioned as a potential worry in another study. 32 Importantly, the multitude of (false) alarms in our study was perceived as excessive, which may cause alarm fatigue and may be a major barrier for successful implementation. In several other studies, nurses also reported frequent (false) alarms to be the biggest disruptive factor for their work processes.…”

“…The potential bene t for patients was also recognized by nurses in several other studies with a CMVS systems, speci cally for earlier detection of clinical deterioration in certain high risk patient groups and providing remote insight in the patients vital signs during night shifts. 14,31,32,36 Unfortunately, contrary to common belief among nurses strong evidence for clinical bene t and cost-effectiveness is still lacking due to the various study designs, low study quality and various outcome measures used in available published reports. 11,40 However, providing nursing care according to the principles of Evidence-Based Practice is more than just the following the evidence, but also consists the preferences of the patient and clinical expertise of the nurses.…”

Effect of Intelligent Vital Sign Monitoring System on Postoperative Nursing Care of Severe Patients

“…On the other hand, all kinds of collected data are drawn and displayed, and preliminary analysis and diagnosis are made. If it is judged that there is a critical situation, it will immediately send text messages and automatically dial the alarm for help [ 18 ].…”

Nurses’ experiences with continuous vital sign monitoring on the general surgical ward: a qualitative study based on the Behaviour Change Wheel

“…Obviously, nurses’ observations on the patient status and possible clinical deterioration is much more than just monitoring vital signs. Current sensors and vital sign trends still do not include factors such as the nurse worry factor and the critical EWS component ‘level of consciousness’ [ 32 – 34 ]. In line with other studies, the value of the nurse’s clinical observations in detection of deterioration was also with respect to reservations about a potential decrease in the bedside nurse-patient contacts by using CMVS which may limit the value of their clinical judgement [ 15 , 35 , 36 ].…”