Surgical Ward Innovation: Telemonitoring Controlled by Healthdot

Study Overview
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Brief Summary
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This observational clinical, single center trial is designed to evaluate the implementation of an already validated smart monitoring device, the Philips Healthdot, on one surgical ward at the Catharina hospital in Eindhoven, The Netherlands. This study is performed during 6 months in which all patients admitted to one surgical ward will be enrolled. Implementation is established by a step-by-step approach in which the current manually performed spot check monitoring (blood pressure, oxygen saturation, respiratory rate, heart rate, temperature and pain score), with the early warning score (EWS), is continued besides smart monitoring with the Healthdot (respiratory rate, heart rate and physical activity) during the first three months (phase 1). This phase aims at optimizing the infrastructure, education of hospital staff and practice with application/ activation and interpretation of the device. Upward of 4 months, Healthdot monitoring will be the primary monitoring method and spot check monitoring is only performed additionally in case of doubt about clinical condition or requirement of additional vital parameters. Evaluation of the implementation will be performed with a focus group and various questionnaire regarding fidelity, acceptability, adoption, feasibility, appropriateness and costs. Thereby additional analysis regarding monitoring algorithms will be performed.

Detailed Description
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This project is a 6 months monocenter prospective cohort study at the Catharina hospital in the Netherlands. Every patient admitted to the one surgery department will receive a Healthdot. Implementation of the Healthdot will be performed stepwise. During phase 1 (month 1-3, the pre-implementation phase), the current standard method of care with manual spot checks and EWS will be continued. During this phase Healthdots will be applied only for training purposes in preparation to the implementation phase, phase 2 (month 3-6). This phase consists of primarily Healthdot monitoring and manual spot checks only if indicated. After these 6 months, the implementation will be evaluated and optimized and potentially extended. Participants: The main research population for answering the research objectives are the nurses working at the specific surgical ward at the Catharina hospital. In total amount of 500 patients, 250 during each phase, admitted to one surgical ward at the Catharina hospital will participate and receive a Healthdot as the new standard of care. These patients will sign informed consent for use of anonymized data. This population differs in age, gender, admission cause, admission duration and comorbidities but reflects the demographics of the general population on this ward which is essential to investigate implementation and prevent selection bias.

Official Title
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SWITCH- Surgical Ward Innovation: Telemonitoring Controlled by Healthdot Evaluation of Implementation

Conditions
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Monitoring

Intervention / Treatment
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* Device: Evaluation of implementation regarding Philips Healthdot as monitoring device of hospitalized patients at one surgical ward


Participation Criteria
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Eligibility Criteria
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Nurses and physicians form the primary research population. - Nurses and physicians, participating in het focus group will sign informed consent. Patients won't be included for participation since the Healthdot will be the new standard of care regarding monitoring. Patients will however sign informed consent at admission for use of anonymized data. Inclusion Criteria: Nurses Registered in the national register of medical professions (Big register) Appointed as a nurse at the Catharina hospital and working at the surgical department during the study period Willingness to participate in the core group for evaluation of the implementation Physicians Registered in the national register of medical professions (Big register) Appointed at the Catharina hospital as a physician or resident during the study period. Willingness to participate in the core group for evaluation of the implementation Exclusion Criteria: Nurses & Physicians Termination of employment within the study period No voluntarily participation in the core group evaluation meetings Contra-indications for applying Healthdot Known to have severe allergy for the tissue adhesive used in the Healthdot. Any skin condition, for example prior severe rash, discoloration, scars or open wounds at the area of application Pregnant, or breastfeeding Use of topicals that are known to irritate the skin at the application area (such as medical and non-medical creams or lotions) Patient with active implantable device such as a Implantable Cardiac Defibrillator (ICD) or pacemaker Unable to understand instructions Left lower rib (place where Healthdot will be applied) is involved in the area of surgery, area of disinfection or area where bandages are needed. Transfer to a different ward during hospitalization

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Device: Evaluation of implementation regarding Philips Healthdot as monitoring device of hospitalized patients at one surgical ward|Hospitalized patients at one surgical ward will receive a Healthdot as monitoring device which will be used as primary monitoring after 3 months of preparation with education of hospital staff, improving infrastructure and training with application, activation and interpretation|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of the implementation of a continuous monitoring method on the surgical ward | Workload: the experienced workload for nursing staff during the implementation of the Healthdot measured with the IWS and during focus group analysis | Conducted on a daily base during the entire study, month 1-6 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adoption | The intention and attitude towards the use of the Healthdot monitoring method. Measured with evidence-based practise attitude scale (EBPAS) | 3 focus groups sessions at month 3, 5 and 6 | 
| Feasibility of the Healthdot | The extent to which the Healthdot monitoring method can be successfully carried out by the healthcare employees. Measured with a thematic analysis and input from the core group (Braun and Clark) | 3 focus groups sessions at month 3, 5 and 6 | 
| Acceptability | The additional effort regarding the amount of spot checks per hospital admission day per patient. Calculated with data from the electronic patient file records | Evaluated at month 4 and 6 | 
| Appropriateness | Relation between device false alarms (noise) and correct alarms based on the alarming protocol. Measured as signal to noise ratio (SNR) | Evaluated after at month 4 and 6 | 
| Usability | Number of unexpected events that occur during or result from the use of the Healthdot medical device. Measured as adverse device events (ADE) | Evaluated after at month 4 and 6 | 
| Feasibility and effectiveness | The amount of time needed to perform and process a complete manual spot check or digital monitoring check. Measured by manual time measurement | Manual time measurement during month 1-6, 2 times a week at different days | 
| Costs | Cost-effectiveness analysis based on the duration of admission, the associated admission costs and the monitoring method. Calculation based on provided care and associated costs | After completing of the study at 6 months | 
| Algorithm improvement | Advanced algorithm analyses for improved monitoring protocols with use of artificial intelligence (AI) | After completing of the study at 6 months |