Background: Disrupted sleep is a common complaint among hospitalized patients and is associated with adverse outcomes including the development of delirium. Wearable vital sign monitoring devices (VSMDs) are emerging alternatives to nurse-collected vitals that could replace the need for overnight vital checks. This study assesses patient and nurse attitudes toward an FDA-cleared VSMD (Caretaker-4), including its impact on patient sleep and nurse delivery of care. The study also compares device data completeness to nurse-collected data to evaluate how well the device approximates standard-of-care vital sign collection
Methods: In this prospective cohort study, we enrolled adults admitted to a neurosciences unit and provided them with a Caretaker-4, which collects continuous blood pressure (BP), heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), and temperature. Questionnaires were administered on study completion after device was worn for at least one night. Patients continued to receive vital checks by nursing staff as prescribed during the study period. Nurses who cared for patients for at least one 8-hour shift were asked to complete a separate questionnaire. Questionnaires included a Likert scale range from strongly disagree (1) to strongly agree (5).
Results: We enrolled 21 patients and 15 nurses over two months. Median patient age was 42 (IQR 29, 50) and median nurse age was 31 (IQR 28, 44). Patients wore the device for 1-3 nights. Patients were neutral toward the device being comfortable (average score 3.3±1.0) and pleasant to wear overnight (average score 3.0±1.0). Overall, patients reported the device was less disruptive (average score 4.1±0.8) and said most patients would prefer this device compared with nurse-collected vital checks overnight (average score 4.3±0.9). Nurses did not find that the device interfered with their patient care responsibilities (average score 1.9±0.9) and agreed that the device was more efficient than manual vital checks (average score 3.7±1.1). In terms of data completeness, the device effectively recorded BP, HR, and RR during the timestamps of 72% of nurse vital checks. That number was 42% for SpO2 and 49% for temperature. Lost data was due to battery death overnight, lost Bluetooth connection, or after-hours removal of the device for imaging. The pulse oximeter fell off overnight for 9 (43%) participants.
Conclusions: VSMDs have potential to improve sleep-related patient outcomes and nursing workflow on low-acuity inpatient wards. Patients favored using this VSMD over manual overnight vital signs, although adjustments in form factor in future models should address neutral patient comfort scores. Nurses felt positively about the integration of this VSMD into patient care. The device suffered from inconsistency in data streaming, which could be addressed by nurse training in device re-application and battery charging. Remote VSMDs are a promising way to reduce sleep disruption and should be studied in a larger cohort encompassing a greater diversity of medical services and acuity levels.