Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study
<h4>Background</h4> Continuous monitoring of vital signs is introduced at general hospital wards to detect patient deterioration. Interpretation and response currently rely on experience and expert opinion. This study aims to determine whether consensus exist among hospital professionals...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10212076/?tool=EBI |
| _version_ | 1827940182394929152 |
|---|---|
| author | Harriët M. R. van Goor Martine J. M. Breteler Lisette Schoonhoven Cor J. Kalkman Kim van Loon Karin A. H. Kaasjager |
| author_facet | Harriët M. R. van Goor Martine J. M. Breteler Lisette Schoonhoven Cor J. Kalkman Kim van Loon Karin A. H. Kaasjager |
| author_sort | Harriët M. R. van Goor |
| collection | DOAJ |
| description | <h4>Background</h4> Continuous monitoring of vital signs is introduced at general hospital wards to detect patient deterioration. Interpretation and response currently rely on experience and expert opinion. This study aims to determine whether consensus exist among hospital professionals regarding the interpretation of vital signs of COVID-19 patients. In addition, we assessed the ability to recognise respiratory insufficiency and evaluated the interpretation process. <h4>Methods</h4> We performed a mixed methods study including 24 hospital professionals (6 nurses, 6 junior physicians, 6 internal medicine specialists, 6 ICU nurses). Each participant was presented with 20 cases of COVID-19 patients, including 4 or 8 hours of continuously measured vital signs data. Participants estimated the patient’s situation (‘improving’, ‘stable’, or ‘deteriorating’) and the possibility of developing respiratory insufficiency. Subsequently, a semi-structured interview was held focussing on the interpretation process. Consensus was assessed using Krippendorff’s alpha. For the estimation of respiratory insufficiency, we calculated the mean positive/negative predictive value. Interviews were analysed using inductive thematic analysis. <h4>Results</h4> We found no consensus regarding the patient’s situation (α 0.41, 95%CI 0.29–0.52). The mean positive predictive value for respiratory insufficiency was high (0.91, 95%CI 0.86–0.97), but the negative predictive value was 0.66 (95%CI 0.44–0.88). In the interviews, two themes regarding the interpretation process emerged. “Interpretation of deviations” included the strategies participants use to determine stability, focused on finding deviations in data. “Inability to see the patient” entailed the need of hospital professionals to perform a patient evaluation when estimating a patient’s situation. <h4>Conclusion</h4> The interpretation of continuously measured vital signs by hospital professionals, and recognition of respiratory insufficiency using these data, is variable, which might be the result of different interpretation strategies, uncertainty regarding deviations, and not being able to see the patient. Protocols and training could help to uniform interpretation, but decision support systems might be necessary to find signs of deterioration that might otherwise go unnoticed. |
| first_indexed | 2024-03-13T09:05:22Z |
| format | Article |
| id | doaj.art-086a049960c3465894f83fffb227d65e |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-03-13T09:05:22Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-086a049960c3465894f83fffb227d65e2023-05-28T05:31:17ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01185Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods studyHarriët M. R. van GoorMartine J. M. BretelerLisette SchoonhovenCor J. KalkmanKim van LoonKarin A. H. Kaasjager<h4>Background</h4> Continuous monitoring of vital signs is introduced at general hospital wards to detect patient deterioration. Interpretation and response currently rely on experience and expert opinion. This study aims to determine whether consensus exist among hospital professionals regarding the interpretation of vital signs of COVID-19 patients. In addition, we assessed the ability to recognise respiratory insufficiency and evaluated the interpretation process. <h4>Methods</h4> We performed a mixed methods study including 24 hospital professionals (6 nurses, 6 junior physicians, 6 internal medicine specialists, 6 ICU nurses). Each participant was presented with 20 cases of COVID-19 patients, including 4 or 8 hours of continuously measured vital signs data. Participants estimated the patient’s situation (‘improving’, ‘stable’, or ‘deteriorating’) and the possibility of developing respiratory insufficiency. Subsequently, a semi-structured interview was held focussing on the interpretation process. Consensus was assessed using Krippendorff’s alpha. For the estimation of respiratory insufficiency, we calculated the mean positive/negative predictive value. Interviews were analysed using inductive thematic analysis. <h4>Results</h4> We found no consensus regarding the patient’s situation (α 0.41, 95%CI 0.29–0.52). The mean positive predictive value for respiratory insufficiency was high (0.91, 95%CI 0.86–0.97), but the negative predictive value was 0.66 (95%CI 0.44–0.88). In the interviews, two themes regarding the interpretation process emerged. “Interpretation of deviations” included the strategies participants use to determine stability, focused on finding deviations in data. “Inability to see the patient” entailed the need of hospital professionals to perform a patient evaluation when estimating a patient’s situation. <h4>Conclusion</h4> The interpretation of continuously measured vital signs by hospital professionals, and recognition of respiratory insufficiency using these data, is variable, which might be the result of different interpretation strategies, uncertainty regarding deviations, and not being able to see the patient. Protocols and training could help to uniform interpretation, but decision support systems might be necessary to find signs of deterioration that might otherwise go unnoticed.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10212076/?tool=EBI |
| spellingShingle | Harriët M. R. van Goor Martine J. M. Breteler Lisette Schoonhoven Cor J. Kalkman Kim van Loon Karin A. H. Kaasjager Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study PLoS ONE |
| title | Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study |
| title_full | Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study |
| title_fullStr | Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study |
| title_full_unstemmed | Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study |
| title_short | Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study |
| title_sort | interpretation of continuously measured vital signs data of covid 19 patients by nurses and physicians at the general ward a mixed methods study |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10212076/?tool=EBI |
| work_keys_str_mv | AT harrietmrvangoor interpretationofcontinuouslymeasuredvitalsignsdataofcovid19patientsbynursesandphysiciansatthegeneralwardamixedmethodsstudy AT martinejmbreteler interpretationofcontinuouslymeasuredvitalsignsdataofcovid19patientsbynursesandphysiciansatthegeneralwardamixedmethodsstudy AT lisetteschoonhoven interpretationofcontinuouslymeasuredvitalsignsdataofcovid19patientsbynursesandphysiciansatthegeneralwardamixedmethodsstudy AT corjkalkman interpretationofcontinuouslymeasuredvitalsignsdataofcovid19patientsbynursesandphysiciansatthegeneralwardamixedmethodsstudy AT kimvanloon interpretationofcontinuouslymeasuredvitalsignsdataofcovid19patientsbynursesandphysiciansatthegeneralwardamixedmethodsstudy AT karinahkaasjager interpretationofcontinuouslymeasuredvitalsignsdataofcovid19patientsbynursesandphysiciansatthegeneralwardamixedmethodsstudy |