Clinician Perspectives on Continuous Monitor Use in a Children's Hospital: A Qualitative Study

Area of Science:

• Pediatric critical care medicine
• Clinical decision-making
• Healthcare technology assessment

Background:

• Continuous cardiopulmonary monitors (cCPMs) exhibit variable use in pediatric hospitals, suggesting subjective decision-making.
• Understanding the rationale behind cCPM utilization is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

• To investigate the decision-making processes of clinical providers regarding the use of continuous cardiopulmonary monitors (cCPMs) in a pediatric setting.
• To identify factors influencing the initiation and discontinuation of cCPM use among healthcare professionals.

Main Methods:

• A qualitative study involving semi-structured interviews with nurses, respiratory therapists (RTs), and physicians across two hospital medicine units.
• Thematic analysis of interview transcripts, incorporating patient case scenarios and open-ended questions to explore clinical workflows and decision-making.

Main Results:

• Clinicians frequently initiate cCPMs as a default at admission, viewing them as a tool to manage clinical uncertainty.
• Despite perceived flaws, cCPMs are considered low-risk interventions. Physicians primarily decide on discontinuation, with no standardized process in place.
• Nurses and RTs monitor patient status and alarms closely, while physicians hold the authority for device removal.

Conclusions:

• Healthcare teams often default to cCPM use without a structured protocol for discontinuation, contributing to potentially prolonged monitoring.
• Future interventions to reduce cCPM utilization must address the factors driving default use and the absence of standardized discontinuation criteria.