Characterising clinically integrated remote sensing and digital alerting tools for the assessment of health status in community and hospital care

Abstract

Remote monitoring and digital alerting tools have gained momentum in their popularity, ow- ing to both recent technological advances and the COVID-19 pandemic, facilitating a more digitised workflow. Continuous remote monitoring of vital signs, using wearable sensors, pro- vide additional datapoints which may result in earlier detection of deterioration and treatment; therefore, improving clinical outcomes. A system was chosen based on previous validation and usability research, this was a wear- able sensor which measured axillary temperature, heart and respiratory rates every 2 minutes. Upon breeching tailorable thresholds, alerts were sent to healthcare professionals requesting acknowledgement with the subsequent clinical action recorded. The implementation of this system was tested in two parallel streams. Firstly, in community settings through repositioned hotels; the system was used to assess a proof-of-concept model of healthcare delivery for individuals requiring mandatory isolation for COVID-19. In total, 10 vital alerts were generated across 4 participants, resulting in telephone contact, reassurance, or adjustment of the sensor. Secondly, in an acute secondary care surgical setting, there were no significant di↵erences in planned and unplanned intensive care admissions, hospital length of stay, or 28-day mortality. Mixed-methods analyses of barriers and facilitators for implementation of remote monitoring and digital alerting tools within complex health organisations was conducted. Technological acceptance and key evaluation measures were mapped to system use (human), user satisfaction (human), environment (organisation), structure (organisation), information and service quality (technology), and system quality (technology). Remote sensing and digital alerting tools can enhance healthcare delivery and workflows. This thesis delivers key recommendations to push healthcare systems into a digitally enabled era which can improve patient safety, targeting the failure to recognise and escalate phenomenon of clinically deteriorating patients.