Evaluation of IMPALA 2.0: Addressing Patient Monitoring in Low-Resource Hospitals in Malawi

Background
Patient monitoring systems (PMSs) are essential for monitoring and managing the condition of critically ill patients. In low-resource settings, limited access to technology, low-level digital literacy, and power outage challenges are usability concerns. The main aim of this study was to evaluate the usability of the IMPALA (Innovative Monitoring in Paediatrics in Low-resource settings: an Aid to save lives) PMS optimized for use in low-resource settings by assessing the opinions and experiences of 24 healthcare professionals.

Material/Methods
The study used a mixed-method design, combining quantitative and qualitative approaches. Quantitatively, 24 participants (nurses and clinicians) completed the Usefulness, Satisfaction, and Ease of Use questionnaire to assess the PMS usability. Qualitatively, contextual inquiry and co-design sessions provided insights into users’ experiences and identified usability issues. Data were analyzed using descriptive statistics and thematic analysis.

Results
The PMS was rated 9.13 for usefulness, 8.49 for user satisfaction, 7.83 for ease of use, and 7.60 for ease of learning. Reported challenges included lack of knowledge/skills due to limited previous exposure (70.8%), frequent sensor detachment (58.3%), inaccurate SpO2 readings (37.5%), and frequent/false alarms (33.3%). Contextual inquiry revealed that patient movement and poorly fitting sensors often caused inaccurate readings, leading to false alarms and potential patient safety risks.

Conclusions
Successful implementation of PMSs in a low-resource setting requires specific contextual user-centered design and training. Applying this, the IMPALA system yielded high usability scores. Further improvement should focus on expanded battery life, robust and durable SpO2 sensors, and tailored training methods.