Factors Associated With the Usability and Adoption of Continuous Monitoring Devices With Deterioration Alerting Systems in Acute Hospital Non-ICU Settings: A Mixed Methods Study.

AIM: To identify factors associated with usability and adoption of continuous monitoring with deterioration alerting systems (CM-DAS) in non-ICU wards from clinicians' perspectives.

BACKGROUND

Patient deterioration is a safety concern on general wards; intermittent vital sign checks can miss early decline. CM-DAS can help, but impact depends on usability and clinician adoption, which remain variably achieved.

METHODS

Convergent mixed methods using the unified theory of acceptance and use of technology (UTAUT) model to guide data collection: An online UTAUT-based survey (n = 111 clinicians, 20 countries; April-August 2023) and semistructured interviews (n = 10) were conducted. Quantitative data were analysed with nonparametric tests and composite PLS-SEM (3000 bootstraps); qualitative data underwent thematic analysis; findings were integrated narratively.

RESULTS

Perceived usefulness and ease of use were positively associated with the intention to adopt CM-DAS. In the multivariable PLS-SEM, only intention to use the system (β ˜ 0.29, p ˜ 0.01) and prior CM-DAS experience (β ˜ 0.28, p ˜ 0.01) were associated with routine bedside use; other constructs did not retain independent associations, and variance explained was modest (R2_use≈0.15). Interviews corroborated benefits (patient safety and workflow) and highlighted barriers-false alarms, reliability/connectivity issues, technical language/user interface and gaps in support and training. Peer practices and patient/family responses shaped the climate for adoption.

CONCLUSIONS

This study suggests that ensuring reliable infrastructure (signal stability, hospital Wi-Fi and integration with EHR) is foundational for safe and sustained CM-DAS operation. Routine use was most closely associated with clinicians' intention to use the system and accumulated experience. Factors such as how easy a system is to use and how individuals perceived its usefulness strengthened an individual's intention to use the system.

IMPLICATIONS FOR NURSING MANAGEMENT: Management should prioritise reliable infrastructure, implement tiered alarm governance to reduce nonactionable alerts, designate ward super-users supported by vendor service-level agreements and deliver brief, recurring, practice-embedded training so that intention translates into sustained, safe bedside use.