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Boswell CL, Minteer SA, Herasevich S, Garcia-Mendez JP, Dong Y, Gajic O, Barwise AK. Early Prevention of Critical Illness in Older Adults: Adaptation and Pilot Testing of an Electronic Risk Score and Checklist. J Prim Care Community Health 2024; 15:21501319241231238. [PMID: 38344983 PMCID: PMC10863481 DOI: 10.1177/21501319241231238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE Given limited critical care resources and an aging population, early interventions to prevent critical illness are vital. In this work, we measured post-implementation outcomes after introducing a novel electronic scoring system (Elders Risk Assessment-ERA) and a risk-factor checklist, Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN), to detect older patients at high risk of critical illness in a primary care setting. METHODS The study was conducted at a family medicine clinic in Kasson, MN. The ADAPT-ITT framework was used to modify the CERTAIN checklist for primary care during 2 co-design workshops involving interdisciplinary clinicians, held in April 2023. The ERA score and modified CERTAIN checklist were implemented between May and July 2023 and identify and assess all patients age ≥60 years at risk of critical illness during their primary care visits. Implementation outcomes were evaluated at the end of the study via an anonymous survey and EHR data extraction. RESULTS Fourteen clinicians participated in 2 co-design workshops. A total of 19 clinicians participated in a post-pilot survey. All survey items were rated on a 5-point Likert type scale. Mean acceptability of the ERA score and checklist was rated 3.35 (SD = 0.75) and 3.09 (SD = 0.64), respectively. Appropriateness had a mean rating of 3.38 (SD = 0.82) for the ERA score and 3.19 (SD = 0.59) for the checklist. Mean feasibility was rated 3.38(SD = 0.85) and 2.92 (SD = 0.76) for the ERA score and checklist, respectively. The adoption rate was 50% (19/38) among clinicians, but the reach was low at 17% (49/289) of eligible patients. CONCLUSIONS This pilot study evaluated the implementation of an intervention that introduced the ERA score and CERTAIN checklist into a primary care practice. Results indicate moderate acceptability, appropriateness, and feasibility of the ERA score, and similar ratings for the checklist, with slightly lower feasibility. While checklist adoption was moderate, reach was limited, indicating inconsistent use. RECOMMENDATIONS We plan to use the open-ended resurvey responses to further modify the CERTAIN-FM checklist and implementation process. The ADAPT-ITT framework is a useful model for adapting the checklist to meet the primary care clinician needs.
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Sevilla-Berrios R, O'Horo JC, Schmickl CN, Erdogan A, Chen X, Garcia Arguello LY, Dong Y, Kilickaya O, Pickering B, Kashyap R, Gajic O. Prompting with electronic checklist improves clinician performance in medical emergencies: a high-fidelity simulation study. Int J Emerg Med 2018; 11:26. [PMID: 29704128 PMCID: PMC5924513 DOI: 10.1186/s12245-018-0185-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/09/2018] [Indexed: 11/30/2022] Open
Abstract
Background Inefficient processes of care delivery during acute resuscitation can compromise the “Golden Hour,” the time when quick interventions can rapidly determine the course of the patient’s outcome. Checklists have been shown to be an effective tool for standardizing care models. We developed a novel electronic tool, the Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) to facilitate standardized evaluation and treatment approach for acutely decompensating patients. The checklist was enforced by the use of a “prompter,” a team member separate from the leader who records and reviews pertinent CERTAIN algorithms and verbalizes these to the team. Our hypothesis was that the CERTAIN model, with the use of the tool and a prompter, can improve clinician performance and satisfaction in the evaluation of acute decompensating patients in a simulated environment. Methods Volunteer clinicians with valid adult cardiac life support (ACLS) certification were invited to test the CERTAIN model in a high-fidelity simulation center. The first session was used to establish a baseline evaluation in a standard clinical resuscitation scenario. Each subject then underwent online training before returning to a simulation center for a live didactic lecture, software knowledge assessment, and practice scenarios. Each subject was then evaluated on a scenario with a similar content to the baseline. All subjects took a post-experience satisfaction survey. Video recordings of the pre-and post-test sessions were evaluated using a validated method by two blinded reviewers. Results Eighteen clinicians completed baseline and post-education sessions. CERTAIN prompting was associated with reduced omissions of critical tasks (46 to 32%, p < 0.01) and 12 out of 14 general assessment tasks were completed in a more timely manner. The post-test survey indicated that 72% subjects felt better prepared during an emergency scenario using the CERTAIN model and 85% would want to be treated with the CERTAIN if they were critically ill. Conclusion Prompting with electronic checklist improves clinicians’ performance and satisfaction when dealing with medical emergencies in high-fidelity simulation environment. Electronic supplementary material The online version of this article (10.1186/s12245-018-0185-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ronaldo Sevilla-Berrios
- Department of Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic, Rochester, MN, USA.,METRIC, Mayo Clinic, Rochester, MN, USA
| | - John C O'Horo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic, Rochester, MN, USA.,METRIC, Mayo Clinic, Rochester, MN, USA
| | - Christopher N Schmickl
- Department of Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic, Rochester, MN, USA.,METRIC, Mayo Clinic, Rochester, MN, USA
| | - Aysen Erdogan
- METRIC, Mayo Clinic, Rochester, MN, USA.,Department of Anesthesiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.,Department of Anesthesiology and Reanimation, Suleyman Demirel University, Isparta, Turkey
| | - Xiaomei Chen
- Department of Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic, Rochester, MN, USA.,METRIC, Mayo Clinic, Rochester, MN, USA.,Department of Critical Care Medicine, Qilu Hospital of Shandong University, Shandong, China
| | - Lisbeth Y Garcia Arguello
- Department of Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic, Rochester, MN, USA.,METRIC, Mayo Clinic, Rochester, MN, USA
| | - Yue Dong
- Department of Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic, Rochester, MN, USA.,METRIC, Mayo Clinic, Rochester, MN, USA
| | - Oguz Kilickaya
- METRIC, Mayo Clinic, Rochester, MN, USA.,Department of Anesthesiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.,Department of Anesthesiology and Reanimation, Gulhane Medical Faculty, Ankara, Turkey
| | - Brain Pickering
- METRIC, Mayo Clinic, Rochester, MN, USA.,Department of Anesthesiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Rahul Kashyap
- METRIC, Mayo Clinic, Rochester, MN, USA. .,Department of Anesthesiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - Ognjen Gajic
- Department of Medicine, Division of Pulmonary and Critical Care Medicine Mayo Clinic, Rochester, MN, USA.,METRIC, Mayo Clinic, Rochester, MN, USA
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Effect of daily use of electronic checklist on physical rehabilitation consultations in critically ill patients. J Crit Care 2016; 38:357-361. [PMID: 28043721 DOI: 10.1016/j.jcrc.2016.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/28/2016] [Accepted: 12/17/2016] [Indexed: 11/21/2022]
Abstract
RATIONALE In intensive care unit (ICU) practice, great emphasis is placed on the functional stabilization of the major organ systems, sometimes at the expense of physical rehabilitation. Checklists have shown to be an effective tool for standardizing care models. Our aim was to the study the effect of the use of an electronic checklist on occupational therapy/physical therapy (OT-PT) consults in critically ill patients. METHODS A retrospective observational study of all adults admitted for the first time in an academic medical ICU in year 2014 was conducted. The patient demographics, outcomes, checklist use, and physical therapy consults were collected from Electronic Medical Records (EMR). RESULTS A total of 2399 unique patients were admitted to the medical ICU, 55% were male and median (IQR) age was 65 (52-77) years. A total of 17% of patients received OT-PT consults among patients with checklist use (N=1897), and among non-checklist user (N=502), it was 7.6%. The total time of OT-PT administered in the ICU was 48 vs 31min, p=0.08.The patients who received the daily electronic checklist had high medical acuity but had lower ICU mortality. Hospital mortality was found to be no different. CONCLUSIONS The use of the electronic checklist in the ICU was associated with increased number of the OT-PT consults.
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Erdogan A, Dong Y, Chen X, Schmickl C, Sevilla Berrios RA, Garcia Arguello LY, Kashyap R, Kilickaya O, Pickering B, Gajic O, O'Horo JC. Development and validation of clinical performance assessment in simulated medical emergencies: an observational study. BMC Emerg Med 2016; 16:4. [PMID: 26772732 PMCID: PMC4715281 DOI: 10.1186/s12873-015-0066-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 12/07/2015] [Indexed: 11/24/2022] Open
Abstract
Background Critical illness is a time-sensitive process which requires practitioners to process vast quantities of data and make decisions rapidly. We have developed a tool, the Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN), aimed at enhancing care delivery in such situations. To determine the efficacy of CERTAIN and similar cognitive aids, we developed rubric for evaluating provider performance in a simulated medical resuscitation environments. Methods We recruited 18 clinicians with current valid ACLS certification for evaluation in three simulated medical scenarios designed to mimic typical medical decompensation events routinely experienced in clinical care. Subjects were stratified as experienced or novice based on prior critical care training. A checklist of critical actions was designed using face validity for each scenario to evaluate task completion and performance. Simulation sessions were video recorded and scored by two independent raters. Construct validity was assessed under the assumption that experienced clinicians should perform better than novice clinicians on each task. Reliability was assessed as percentage agreement, kappa statistics and Bland-Altman plots as appropriate. Results Eleven experts and seven novices completed evaluation. The overall agreement on common checklist item completion was 84.8 %. The overall model achieved face validity and was consistent with our construct, with experienced clinicians trending towards better performance compared to novices for accuracy and speed of task completion. Conclusions A standardized video assessment tool has potential to provide a valid and reliable method to assess 12 performances of clinicians facing simulated medical emergencies. Electronic supplementary material The online version of this article (doi:10.1186/s12873-015-0066-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aysen Erdogan
- Department of Medicine, Mayo Clinic, Rochester, MN, USA. .,Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA. .,Department of Anesthesiology and Reanimation, Suleyman Demirel University, Isparta, Turkey. .,METRIC group, Mayo Clinic, Rochester, MN, USA.
| | - Yue Dong
- Department of Medicine, Mayo Clinic, Rochester, MN, USA. .,METRIC group, Mayo Clinic, Rochester, MN, USA.
| | - Xiaomei Chen
- Department of Medicine, Mayo Clinic, Rochester, MN, USA. .,Department of Critical Care Medicine, Qilu Hospital of Shandong University, Shandong, China.
| | - Christopher Schmickl
- Department of Medicine, Mayo Clinic, Rochester, MN, USA. .,METRIC group, Mayo Clinic, Rochester, MN, USA. .,Department of Internal Medicine, Boston University Medical Center, Boston, MA, USA.
| | - Ronaldo A Sevilla Berrios
- Department of Medicine, Mayo Clinic, Rochester, MN, USA. .,METRIC group, Mayo Clinic, Rochester, MN, USA.
| | - Lisbeth Y Garcia Arguello
- Department of Medicine, Mayo Clinic, Rochester, MN, USA. .,METRIC group, Mayo Clinic, Rochester, MN, USA.
| | - Rahul Kashyap
- Department of Medicine, Mayo Clinic, Rochester, MN, USA. .,METRIC group, Mayo Clinic, Rochester, MN, USA.
| | - Oguz Kilickaya
- Department of Medicine, Mayo Clinic, Rochester, MN, USA. .,METRIC group, Mayo Clinic, Rochester, MN, USA. .,Department of Anesthesiology and Reanimation, Gulhane Medical Faculty, Ankara, Turkey.
| | - Brian Pickering
- Department of Medicine, Mayo Clinic, Rochester, MN, USA. .,Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA. .,METRIC group, Mayo Clinic, Rochester, MN, USA.
| | - Ognjen Gajic
- Department of Medicine, Mayo Clinic, Rochester, MN, USA. .,METRIC group, Mayo Clinic, Rochester, MN, USA.
| | - John C O'Horo
- Department of Medicine, Mayo Clinic, Rochester, MN, USA. .,METRIC group, Mayo Clinic, Rochester, MN, USA.
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