The usability of continuous monitoring devices with deterioration alerting systems in non-critical care units: scoping review

Background:

Delayed recognition of patient deterioration in a non–intensive care unit (ICU) setting contributes to serious adverse events. Continuous monitoring devices with alerting systems offer real-time data to support early detection, but their effectiveness depends on usability. While prior reviews focus on clinical outcomes, usability—defined by effectiveness, efficiency, and satisfaction—remains underexplored.

Objective:

This study aims to scope the evidence related to the usability of continuous monitoring devices with deterioration alerting in noncritical adult care units.

Methods:

A scoping review was conducted following the Joanna Briggs Institute methodology and reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A comprehensive search of MEDLINE, Embase, Emcare, Web of Science, and IEEE Xplore was performed for studies published up to November 2024. Title and abstract screening, full-text review, and data extraction were independently conducted by 2 reviewers. Studies were included if they (1) evaluated the usability—defined as effectiveness, efficiency, or satisfaction—of continuous monitoring devices; (2) focused on adult patients in non-ICU hospital settings; (3) used primary data; (4) were published in English; and (5) described how clinicians received alerts.

Results:

The search identified 1284 papers, with 35 included. Most studies focused on postoperative patients in surgical wards, mainly from the United States and the Netherlands. Only 2 studies used mixed methods, and 10 reported clinician characteristics. While effectiveness (71%) and efficiency (74%) were widely studied, satisfaction (46%) and usability barriers (29%) received less attention.

Conclusions:

Continuous monitoring devices with deterioration alerts may reduce rapid response team calls and ICU transfers, save time, and maintain acceptable alarm frequencies with high user satisfaction. However, usability challenges persist, including technical issues, alarm fatigue, patient discomfort, and limited training or workflow integration. This review mapped current use, usability, and barriers, categorized key usability factors for improvement, and identified the need for further research on clinician perspectives and broader health care settings to enhance generalizability.