The Use of Head-Worn Displays for Vital Sign Monitoring in Critical and Acute Care: Systematic Review.

Francine Elrose,Robert G Loeb,Andrew Hill,David Liu,Penelope Sanderson,Thien Lecong,Isaac Salisbury

doi:10.2196/27165

Francine Elrose, Robert G Loeb + Show 5 more

Open Access

https://doi.org/10.2196/27165

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Abstract

BackgroundContinuous monitoring of patient vital signs may improve patient outcomes. Head-worn displays (HWDs) can provide hands-free access to continuous vital sign information of patients in critical and acute care contexts and thus may reduce instances of unrecognized patient deterioration. ObjectiveThe purpose of the study is to conduct a systematic review of the literature to evaluate clinical, surrogate, and process outcomes when clinicians use HWDs for continuous patient vital sign monitoring. MethodsThe review was registered with PROSPERO (CRD42019119875) and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A literature search was conducted for articles published between January 1995 and June 2020 using the following databases: PubMed, Embase, CINAHL, PsycINFO, and Web of Science. Overall, 2 reviewers independently screened titles and abstracts and then assessed the full text of the articles. Original research articles that evaluated the clinical, surrogate, or process outcomes of head-mounted displays for continuous vital sign monitoring in critical care or acute care contexts were included. ResultsOf the 214 records obtained, 15 (7%) articles met the predefined criteria and were included in this review. Of the 15 studies, 7 (47%) took place in a clinical context, whereas the remainder took place in a simulation environment. In 100% (7/7) of the studies that evaluated gaze behavior, changes were found in gaze direction with HWDs. Change detection improvements were found in 67% (2/3) of the studies evaluating changes in the participants’ ability to detect changes in vital signs. Of the 10 studies assessing the ease of use of the HWD, most participants of 7 (70%) studies reported that the HWD was easy to use. In all 6 studies in which participants were asked if they would consider using the HWD in their practice, most participants responded positively, but they often suggested improvements on the HWD hardware or display design. Of the 7 studies conducted in clinical contexts, none reported any clinical outcomes. ConclusionsAlthough there is limited and sometimes conflicting evidence about the benefits of HWDs from certain surrogate and process outcomes, evidence for clinical outcomes is lacking. Recommendations are to employ user-centered design when developing HWDs, perform longitudinal studies, and seek clinical outcomes. Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42019119875; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119875

Highlights

BackgroundEarly recognition of patient deterioration can improve patient outcomes [1,2,3]
The utility of continuous monitoring for low-intensity patients is still under debate, a recent systematic review focusing on general hospital wards found that continuous vital sign monitoring showed clinical benefits over intermittent monitoring, including reduced critical care use and reduced length of hospital stay, as well as an overall reduction in the cost of patient care [9]
The purpose of this review is to examine the evidence for the effectiveness of head-worn display PRISMA (HWD) for continuous patient vital sign monitoring in hospital or patient transport environments

Summary

Introduction

BackgroundEarly recognition of patient deterioration can improve patient outcomes [1,2,3]. In acute and critical care contexts, vital sign monitoring may reduce preventable in-hospital deaths by improving the early detection of clinical deterioration and allowing for timely intervention to reverse physiological decline [5,6,7]. There are two approaches to in-hospital vital sign monitoring: intermittent and continuous. Continuous monitoring, recognized as a more proactive approach that is typically used for more at-risk patients, involves the continuous capture of vital sign information or information about significant changes, which is transmitted to a display device. Continuous monitoring of patient vital signs may improve patient outcomes. Head-worn displays (HWDs) can provide hands-free access to continuous vital sign information of patients in critical and acute care contexts and may reduce instances of unrecognized patient deterioration

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