Conectar
To explore staff and patient perception of the newly co-developed wearable monitoring system (WMS), including acceptability of use in clinical practice.
Pragmatic qualitative descriptive study.
Semi-structured interviews were conducted with 12 patient participants and eight staff members between June 2023 and August 2024, and were analysed thematically.
Three themes were identified, building on previous qualitative work around the use of WMS on hospital wards. The first theme—centralised continuous monitoring enhances care—explores how WMS provides staff with a means to provide safe, efficient care with the ability to see the vital signs away from the patient. Patients reported feeling safer, knowing they were being monitored when staff were not at the bedside. The second theme—human connection at the bedside—considers how both patients and staff emphasised that the system should not replace nurse/patient interactions and face-to-face care, even though it provided patients with a stronger sense of independence. The final theme—system usability and integration into care—focuses on use of the system in clinical practice and implications for the future.
Wearable monitoring systems have the potential to support nurses to provide safer, more efficient care, whilst providing reassurance to patients. However, centralised monitoring should not replace face-to-face clinical contact, and careful consideration should be given to who would benefit most from the technology.
This study extends existing knowledge of the impact of WMS from being a tool to enhance patient safety to an intervention to improve nurse efficiency and patient experience, within the context of a high-demand surgical ward.
Patients and members of the public were involved in study design and data collection. Their contributions included participating in advisory groups, ensuring the research addressed patient-relevant priorities.
Hypertension is the leading risk factor for death globally. Undiagnosed hypertension is common, but the incidence in hospitalised patients is unclear. There are calls for universal facility-based screening for hypertension among all attending patients. The hospital inpatient setting, where blood pressure (BP) is measured routinely and repeatedly, presents an ideal opportunity. However, international hypertension guidelines do not include inpatient BP thresholds for diagnostic or treatment purposes. We investigated the performance of current UK community BP thresholds for diagnosing hypertension in the hospital setting.
Investigate the diagnostic performance of the current UK ambulatory BP diagnostic thresholds for systolic and diastolic hypertension in the hospital setting against the reference test of community-based ambulatory BP monitoring (ABPM).
A prospective diagnostic accuracy study.
Hospital inpatients admitted to three UK centres were approached. Follow-up ABPM was delivered in the community.
Eligible patients were aged between 18 and 80 years, with no prior diagnosis of, or prescription for hypertension, and whose mean cumulative daytime BP was 120 mm Hg to 179 mm Hg systolic and ≤109 mm Hg diastolic from the 24th hour of their hospital admission.
Participants received 24-hour ABPM 4–26 weeks post-discharge, as the reference test for hypertension, with UK diagnostic thresholds of an average daytime BP of ≥135 mm Hg systolic and ≥85 mm Hg diastolic applied. Participants found to be severely hypertensive at the ABPM fitting appointment were also considered reference-test positive but did not proceed with ABPM.
The diagnostic performance of a mean daytime in-hospital BP of ≥135 mm Hg systolic or ≥85 mm Hg diastolic (index test) for the prediction of hypertension diagnosed on ABPM (reference test) was assessed using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) as primary outcome measures. Additionally, we explored the accuracy of a range of alternative in-hospital systolic and diastolic BP thresholds against the same reference test.
351 participants were enrolled and 206 completed the study protocol. The average age of the 206 participants was 53 years, 55% were male, and 91 (44%) had daytime community hypertension on ABPM reference testing. Of 107 participants with raised in-hospital daytime BP, 59 (55%) had daytime community hypertension. When assessing the performance of the index test for detecting daytime community hypertension, sensitivity was 65% (59/91, 54% to 75%) and specificity was 58% (67/115, 49% to 67%). The PPV was 55% (59/107, 45% to 65%) and NPV was 68% (67/99, 58% to 77%), respectively. A further 45/206 participants (23%) had night-time community hypertension when assessed using European diagnostic thresholds for nocturnal hypertension (120 mm Hg systolic or 70 mm Hg diastolic), while 25/107 of those with raised in-hospital daytime BP (23%) had night-time community hypertension. When assessing the performance of the index test for detecting either day or night-time community hypertension, sensitivity was 62% (84/135, 53% to 70%) and specificity was 68% (48/71, 55% to 78%). The PPV was 79% (84/107, 70% to 86%) and NPV was 48% (48/99, 38% to 59%).
Undiagnosed hypertension is common in hospitalised patients, particularly those with raised in-hospital BP. While in-hospital BP alone is an imperfect predictor and should not be used as a stand-alone diagnostic test, this could serve as a trigger for further assessment of BP in the community after discharge.
The study protocol was registered with the ISCTRN Registry (ISRCTN80586284).
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