Vital signs monitoring on general wards: clinical staff perceptions of current practices and the planned introduction of continuous monitoring technology.
OBJECTIVE
Early detection of patient deterioration and prevention of adverse events are key challenges to patient safety. This study investigated clinical staff perceptions of current monitoring practices and the planned introduction of continuous monitoring devices on general wards.


METHODS
Multi-method study comprising structured surveys, in-depth interviews and device trial with log book feedback.


METHODS
Two general wards in a large urban teaching hospital in Sydney, Australia.


METHODS
Respiratory and neurosurgery nursing staff and two doctors.


RESULTS
Nurses were confident about their abilities to identify patients at risk of deterioration, using a combination of vital signs and visual assessment. There were concerns about the accuracy of current vital signs monitoring equipment and frequency of intermittent observation. Both the nurses and the doctors were enthusiastic about the prospect of continuous monitoring and perceived it would allow earlier identification of patient deterioration; provide reassurance to patients; and support interdisciplinary communication. There were also reservations about continuous monitoring, including potential decrease in bedside nurse-patient interactions; increase in inappropriate escalations of patient care; and discomfort to patients.


CONCLUSIONS
While continuous monitoring devices were seen as a potentially positive tool to support the identification of patient deterioration, drawbacks, such as the potential for reduced patient contact, revealed key areas that will require close surveillance following the implementation of devices. Training and improved interdisciplinary communication were identified as key requisites for successful implementation.
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, Sydney NSW 2109, Australia.
Mirela
M
Prgomet
The Simpson Centre for Health Services Research, South Western Sydney Clinical School, Liverpool Hospital, Level 2, Education Building, Corner Elizabeth and Goulburn Streets, Liverpool NSW 2170, Australia.
Magnolia
M
Cardona-Morrell
Intensive Care Unit, Liverpool Hospital, Level 2, Clinical Services Building, Corner Elizabeth and Goulburn Streets, Liverpool NSW 2170, Australia.
Margaret
M
Nicholson
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, Sydney NSW 2109, Australia.
Rebecca
R
Lake
Centre for Health Care Resilience and Implementation Science, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, Sydney NSW 2109, Australia.
Janet
J
Long
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, Sydney NSW 2109, Australia.
Johanna
J
Westbrook
Centre for Health Care Resilience and Implementation Science, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, Sydney NSW 2109, Australia.
Jeffrey
J
Braithwaite
The Simpson Centre for Health Services Research, South Western Sydney Clinical School, Liverpool Hospital, Level 2, Education Building, Corner Elizabeth and Goulburn Streets, Liverpool NSW 2170, Australia Intensive Care Unit, Liverpool Hospital, Level 2, Clinical Services Building, Corner Elizabeth and Goulburn Streets, Liverpool NSW 2170, Australia.
Ken
K
Hillman
D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D005069:Evaluation Studies as Topic; D005260:Female; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D009736:Nursing Process; D061214:Patient Safety; D010362:Patients' Rooms; D055986:Vital Signs; D055815:Young Adult
evaluation studies as topic; general wards; hospitals; monitoring; patient safety; physiological