A Novel Remote Monitoring NIV System Innovation Outside Intensive Care Unit: RT Perceptions

Background:

NIV is commonly utilized outside of the ICU for respiratory support. A novel remote monitoring NIV system (tele-NIV) consisting of streaming real-time NIV data and vital signs from Phillips Intellivue MX400 to assist in RTs streamlining the work processes and efficiently responding to NIV alarms. The workflow using tele-NIV aims to reduce ICU admission for respiratory patients and improve patient care and safety. The tele-NIV system has been implemented since April 2021 at JurongHealth Campus, Singapore, and this study evaluates RTs' perceptions (n = 25) of the tele-NIV system.

Methods:

Using the technology model assessment (TMA) model, a 5-point Likert scale was used for item scoring in the respondents’ 25-question questionnaire. Before further data analysis, the quality and factorability of the data were assessed. Multivariate normality was tested by calculating the mean value of the Mahalanobis squared distances in the data distribution against the critical importance (number of items multiplied by the number of items plus 2). An inter-item correlation matrix was analyzed, and factor analysis was conducted using eigenvalue (>1) to determine the factors. 13 low and cross-loading (<0.65) items were removed from the questionnaire. This study was approved by Institution Ethics Review Board (NHG DSRB 2022/00455).

Results:

Factor analysis was performed, and the final factor models in the instruments represented three factors with a total of 12 items. The total variance explained by the three-factor model was 69.74%. Of the factor-specific percentages, the first factor (6 items), the feasibility of tele-NIV demonstrated at 25.55%; the second-factor perceptions of tele-NIV (3 items) at 23.65%; the third factor, tele-NIV resources and training (3 items) at 17.35%. Cronbach’s alpha was used for internal consistency assessment, and Cronbach’s alpha ranged from 0.820 to 0.935 in the factors. 100% of RTs reported (agree and strongly agree) that tele-NIV is feasible and has proven to help them in their clinical work outside ICU. However, (n = 16, 64%) RTs prefer that nurses and clinicians can be empowered and better trained in managing NIV patients. Coupled with the tele-NIV system, it will optimize efficiency at work and improve patient safety.

Conclusions:

Tele-NIV is a novel approach well-liked by the RTs in terms of feasibility. However, ongoing study and training are being conducted to receive feedback from the nurses, patients, and their caregivers for a holistic review of the tele-NIV system.

Table 1: Respiratory therapists’ perceptions of the importance of the three factors on tele-NIV

IQR– interquartile range; SD– Standard Deviaton

Table 2: Variances explained and reliability testing based from factor analysis

 	Feasibility	Perceptions	Resources and Training
Eigenvalue	7.505	2.565	1.695
Percentage of Variance	25.55%	23.65%	17.35%
The total percentage of factor model explained	69.738%
Cronbach’s Alpha	0.935	0.820	0.851
Cronbach’s Alpha on the total scale	0.937

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