JMIR Publications

ABSTRACT

Background:

Cardiac and major vascular surgeries are common surgical procedures, associated with high rates of post-surgical complications and related hospital readmission. In-hospital remote automated monitoring (RAM) and virtual hospital-to-home patient care systems have major potential to improve patient outcomes following cardiac and major vascular surgery. However, the science of deploying and evaluating these systems is complex and subject to risk of implementation failure.

Objective:

As a precursor to a randomised controlled trial, the purpose of this mixed-methods user testing study was to examine user performance and acceptance of a RAM and virtual hospital-to-home care intervention, using Philip’s Guardian and Electronic Transition to Ambulatory Care (eTrAC) technologies, respectively.

Methods:

Nurses and patients participated in systems training and individual case-based user testing at two participating sites in Canada and the United Kingdom. Participants were video recorded and asked to think aloud while completing required user tasks, and while being rated on user performance. Feedback was also solicited about the user experience, including user satisfaction and acceptance, through use of the Net Promoter Score survey and debrief interviews.

Results:

Thirty-seven participants total (26 nurses, 11 patients) completed user testing. The majority of nurse and patient participants were able to complete most required tasks, independently, demonstrating comprehension and retention of required Guardian and eTrAC system workflows. Tasks which required additional prompting by the facilitator, for some, were related to the use of system features that enable continuous transmission of patient vital signs (e.g., pairing cableless sensors to the patient) and assigning remote patient monitoring protocols. Mean and overall NPS scores, as well as participant debrief interviews, indicated nurse and patient satisfaction and acceptance of the Guardian and eTrAC systems. Both user groups stressed the need for additional opportunities to practice in order to become comfortable and proficient in the use of these systems.

Conclusions:

User testing indicated a high degree of user acceptance of Philips’ Guardian and eTrAC systems among nurses and patients. Key insights were provided that informed refinement of clinical workflow training and systems implementation. These results were used to optimize workflows prior to launch of an international randomized controlled trial of in-hospital RAM and virtual hospital-to-home care, for patients undergoing cardiac and major vascular surgery.