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Surgical Ward Innovation: Primary results of implementation of in-hospital telemonitoring

This prospective observational study demonstrates that implementing a continuous in-hospital telemonitoring system in a surgical oncology ward significantly improved nursing efficiency by reducing routine assessments and perceived workload while increasing system usability and staff acceptance.

Original authors: Friso MJF Schonck, Misha DP Luyer, Evert L Koldewijn, Jurgen MJ Piek, Nardo JM Van Der Meer, Arthur RA Bouwman, Simon W Nienhuijs

Published 2026-06-25

📖 4 min read☕ Coffee break read

CC BY 4.0

Original authors: Friso MJF Schonck, Misha DP Luyer, Evert L Koldewijn, Jurgen MJ Piek, Nardo JM Van Der Meer, Arthur RA Bouwman, Simon W Nienhuijs

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine a busy hospital ward as a bustling train station. In the past, the station managers (the nurses) had to run a manual check on every single passenger (patient) three times a day. They had to stop, ask for a ticket, check a watch, and write it down in a notebook. This was necessary to make sure everyone was safe, but it meant the managers were constantly running back and forth, leaving less time to actually help people with their luggage or answer their questions.

This study, conducted at a surgical oncology ward (a station for patients recovering from cancer surgery), asked: What if we gave every passenger a smart wristband that automatically sends their "heartbeat" and "breathing" data to the manager's computer screen in real-time?

Here is what the researchers found when they tried this new system:

The "Smart Wristband" Experiment

The team gave 469 patients a small, disposable patch (like a high-tech bandage) that stuck to their chest. This patch acted like a silent, continuous observer. Instead of the nurses having to run a manual check three times a day, the patch sent a tiny signal every five minutes, updating a digital dashboard that the nurses could look at whenever they wanted.

The Results: Less Running, More Helping

The study compared the "old way" (running manual checks) with the "new way" (watching the digital dashboard).

The "Stop-and-Go" Slowed Down: Before the new system, nurses had to do a full check on a patient about 3 times a day. After switching to the smart patches, they only needed to do a manual check about 1.8 times a day. That's a 40% reduction in the number of times they had to interrupt the patient.
Time Saved: This change saved the nurses about 10 minutes per patient, every single day. Imagine if you had 10 extra minutes every day to just chat with your family instead of filling out paperwork. That's what the nurses got.
The "Usability" Score Went Up: The nurses were asked to rate how easy the new system was to use on a scale of 0 to 100. At the start, they gave it a 67 (a solid "B"). By the end, after they got used to it, they gave it an 84 (an "A"). They felt much more comfortable and confident with the technology.
Workload Feelings: The nurses felt their workload dropped slightly (from a 5.2 to a 5.0 on a scale of 1 to 9), though this small drop wasn't statistically huge. However, in their group discussions, they agreed that the system made their day feel smoother and less frantic.

The "Trust" Factor

One of the biggest worries was: "If we stop checking manually, will we miss something bad happening?"

The study found that the nurses did not lose trust in the system. In fact, they felt more confident. They liked that the system could spot a problem (like a sudden drop in oxygen) between the times they usually checked. It was like having a security camera that alerts you to a problem instantly, rather than waiting for your next scheduled patrol.

What the Nurses Said (The "Human" Side)

The researchers talked to the staff in group meetings, and a few key themes came up:

Learning Together: The nurses helped each other learn how to use the new tech. One nurse said, "We can learn from each other and complement each other."
It Fits the Job: Because the data went straight into the hospital's computer system, it didn't create extra paperwork. It felt like a natural part of their day.
The Caveat: The nurses were clear that the machine is a helper, not a replacement. They emphasized that the smart patch shouldn't stop them from using their own medical judgment. They also noted that the patches were a bit expensive, which is something to think about if they want to use them everywhere.

The Bottom Line

The study concludes that swapping out the "run-around-and-check" method for a "watch-the-screen" method works well in a surgical ward. It saved time, reduced interruptions for patients, and made the nurses feel more efficient without making them feel like they were taking a risk on patient safety.

In short: The hospital tried a "smart watch" for patients, and it turned out to be a successful way to let nurses spend less time checking vitals and more time caring for people.

Technical Summary: Implementation of In-Hospital Telemonitoring in a Surgical Ward

Problem Statement
Traditional patient surveillance in general hospital wards relies on the Early Warning System (EWS), which involves intermittent, manual assessment of vital signs (typically three times daily). This approach has inherent limitations: it may miss transient but clinically significant physiological abnormalities (e.g., hypoxia or tachycardia) occurring between measurements, potentially delaying the recognition of clinical deterioration. Furthermore, the manual nature of EWS is labor-intensive, requiring repeated bedside measurements and documentation that increase nursing workload and reduce time available for direct patient care. While continuous monitoring has historically been restricted to Intensive Care Units (ICUs) due to equipment bulk and staffing requirements, recent advancements in wearable technology offer the potential for continuous, real-time physiological monitoring in general wards. However, evidence regarding the practical integration of such systems into routine surgical ward workflows, specifically concerning healthcare professional acceptance, workload, and trust in the new processes, remains limited.

Methodology
This study was a single-center, prospective observational study conducted over eight months in the surgical oncology ward of a tertiary care hospital (Catharina Ziekenhuis). The study involved 469 adult patients (primarily postoperative oncology patients) and 15 healthcare professionals (10 nurses and 5 physicians).

The study utilized the Healthdot (Philips), a water-resistant, disposable wearable patch that continuously measures heart rate and respiratory rate via accelerometry. Data is transmitted wirelessly every five minutes to a Guardian system dashboard, which visualizes longitudinal trends and raw data. A Continuous Remote Early Warning Score (CREWS) algorithm was used to interpret the continuous data, validated against conventional manual EWS.

The implementation followed a two-phase protocol:

Phase 1 (Baseline): Wearable devices were applied to patients, but data was not used for clinical decision-making. Routine manual EWS assessments (three times daily) continued. This phase focused on staff training and familiarization.
Phase 2 (Integration): Continuous monitoring data became the primary source for routine surveillance. Routine scheduled bedside vital sign assessments (respiratory rate, heart rate) were discontinued. Additional measurements (blood pressure, temperature, oxygen saturation) were performed only when clinically indicated.

Evaluation Metrics
The study evaluated implementation outcomes using Proctor's implementation framework and standardized instruments:

Primary Outcome: Usability and nursing efficiency, measured by the System Usability Scale (SUS) and the frequency of routine spot-check assessments.
Secondary Outcomes:
- Workload: Assessed via the International Workload Scale (IWS).
- Acceptance: Assessed via the Evidence-Based Practice Attitude Scale (EBPAS) (domains: appeal, openness, etc.).
- Qualitative Data: Focus group interviews analyzed via deductive thematic analysis to explore usability, workflow integration, and barriers.

Key Results

Usability and Efficiency: The System Usability Scale (SUS) score significantly increased from 67% at baseline to 84% after implementation ( $p < 0.05$ ).
Reduction in Manual Assessments: Routine manual spot-check assessments decreased by 40%, corresponding to 1.16 fewer assessments per patient per day. This translated to an estimated time saving of 10 nursing minutes per patient daily.
Workload: The International Workload Scale (IWS) score decreased from 5.2 to 5.0, indicating a lower perceived workload, though this reduction did not reach statistical significance ( $p = 0.110$ ).
Acceptance: EBPAS scores for "appeal" (3.44 to 3.85) and "openness" (3.36 to 3.71) improved significantly ( $p < 0.05$ ), indicating greater acceptance and confidence in the system among nurses.
Qualitative Findings: Focus groups highlighted that successful integration depended on adequate training, peer learning, and the system's ability to reduce administrative burden. Nurses reported that continuous monitoring improved confidence in patient surveillance and allowed for earlier recognition of deterioration between routine checks. However, concerns were raised regarding potential overreliance on technology, the need for adaptation to reduced manual data, and the cost of single-use devices.
Safety: No clinically relevant device malfunctions or substantial data loss occurred. The study observed no negative effects on patient safety or workflow processes.

Significance and Claims
The paper claims that the full-scale implementation of wearable continuous monitoring in a surgical oncology ward is feasible and well-accepted by healthcare professionals. The study suggests that such systems can optimize clinical workflows by substantially reducing routine bedside measurements without compromising confidence in patient safety.

The authors position this work as one of the first studies describing a ward-wide transition from intermittent spot-checks to wearable-supported surveillance in routine clinical practice. They conclude that while technical performance is necessary, successful adoption relies heavily on clinical integration, professional training, and organizational support. The findings support the potential for wearable monitoring to serve as a scalable approach for future surgical ward care, provided that it is implemented as a support tool for clinical assessment rather than a replacement for it. The study explicitly notes that economic evaluation and cost-effectiveness were beyond its scope and will be addressed in future research.