Implementing Wearable Sensors for Clinical Application at a Surgical Ward: Points to Consider before Starting

Abstract

Incorporating technology into healthcare processes is necessary to ensure the availability of high-quality care in the future. Wearable sensors are an example of such technology that could decrease workload, enable early detection of patient deterioration, and support clinical decision making by healthcare professionals. These sensors unlock continuous monitoring of vital signs, such as heart rate, respiration rate, blood oxygen saturation, temperature, and physical activity. However, broad and successful application of wearable sensors on the surgical ward is currently lacking. This may be related to the complexity, especially when it comes to replacing manual measurements by healthcare professionals. This report provides practical guidance to support peers before starting with the clinical application of wearable sensors in the surgical ward. For this purpose, the Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of technology adoption and innovations in healthcare organizations is used, combining existing literature and our own experience in this field over the past years. Specifically, the relevant topics are discussed per domain, and key lessons are subsequently summarized.

Keywords: clinical application; continuous monitoring; surgical ward; technology; vital signs; wearable sensor.

Figure 1

Vital signs and physical activity measurements of a 20-year-old female patient during the first four postoperative days after open fixation of the thoracic spine following multitrauma. Top to bottom: raw measurements of four vital signs (heart rate, respiration rate, temperature, and blood oxygen saturation [SpO₂]) measured by two wearable sensors, an ECG-based sensor (blue) and a PPG-based sensor (orange), by a bedside monitor on the recovery unit (yellow) and by nurses on the surgical ward (black dots). Colored areas represent the limits for points in the Modified Early Warning Score (MEWS) per vital sign. An elevated MEWS (≥4) requires more frequent patient surveillance by hospital protocol (light grey dots). Bottom: physical activity measured as a type of activity and step count by the ECG-based sensor in light blue and dark blue, respectively. Nighttime (11:00 p.m. to 07:00 a.m.) is depicted by grey areas. Data were extracted from an ongoing project in the University Medical Center Groningen (approved by the medical ethical committee, METc 2021/440) for which the patient signed informed consent.