Time accuracy of a barcode system for recording resuscitation events: laboratory trials

Timing errors and temporal uncertainty in clinical databases-A narrative review

A firm concept of time is essential for establishing causality in a clinical setting. Review of critical incidents and generation of study hypotheses require a robust understanding of the sequence of events but conducting such work can be problematic when timestamps are recorded by independent and unsynchronized clocks. Most clinical models implicitly assume that timestamps have been measured accurately and precisely, but this custom will need to be re-evaluated if our algorithms and models are to make meaningful use of higher frequency physiological data sources. In this narrative review we explore factors that can result in timestamps being erroneously recorded in a clinical setting, with particular focus on systems that may be present in a critical care unit. We discuss how clocks, medical devices, data storage systems, algorithmic effects, human factors, and other external systems may affect the accuracy and precision of recorded timestamps. The concept of temporal uncertainty is introduced, and a holistic approach to timing accuracy, precision, and uncertainty is proposed. This quantitative approach to modeling temporal uncertainty provides a basis to achieve enhanced model generalizability and improved analytical outcomes.

Evaluation of comprehensiveness and reliability of electronic health records concerning resuscitation efforts within academic intensive care units: a retrospective chart analysis

Background

According to the literature, the validity and reliability of medical documentation concerning episodes of cardiopulmonary resuscitation (CPR) is suboptimal. However, little is known about documentation quality of CPR efforts during intensive care unit (ICU) stays in electronic patient data management systems (PDMS). This study analyses the reliability of CPR-related medical documentation within the ICU PDMS.

Methods

In a retrospective chart analysis, PDMS records of three ICUs of a single university hospital were searched over 5 y for CPR check marks. Respective datasets were analyzed concerning data completeness and data consistency by comparing the content of three documentation forms (physicians’ log, nurses’ log, and CPR incident form), as well as physiological and therapeutic information of individual cases, for missing data and plausibility of CPR starting time and duration. To compare data reliability and completeness, a quantitative measure, the Consentaneity Index (CI), is proposed.

Results

One hundred sixty-five datasets were included into the study. In 9% (n = 15) of cases, there was neither information on the time points of CPR initiation nor on CPR duration available in any data source. Data on CPR starting time and duration were available from at least two data sources in individual cases in 54% (n = 90) and 45% (n = 74), respectively. In these cases, the specifications of CPR starting time did differ by a median ± interquartile range of 10.0 ± 18.5 min, CPR duration by 5.0 ± 17.3 min. The CI as a marker of data reliability revealed a low consistency of CPR documentation in most cases, with more favorable results, if the time interval between the CPR episode and the time of documentation was short.

Conclusions

This study reveals relevant proportions of missing and inconsistent data in electronic CPR documentation in the ICU setting. The CI is suggested as a tool for documentation quality analysis and monitoring of improvements.

A Tablet-Based Documentation Tool for In-Hospital Resuscitations

The exact documentation of cardiopulmonary resuscitations—in particular the exact time of intervention delivery—is important for checking and improving quality. However, due to time-critical, stressful treatment and mostly retrospective documentation, data quality is often poor. This paper describes the development of a tablet-based application for documentation of in-hospital cardiopulmonary resuscitations that enables real-time documentation by a member of the resuscitation team. The application was developed following a comprehensive user-centered design process. Due to an efficient context-related information architecture, the application has the potential to enable real-time documentation of certain interventions and to accelerate time-consuming documentation after the resuscitation ended. Furthermore, the use of the application may contribute to the optimization of resuscitation processes and resuscitation training by providing more accurate and reliable data.

Real-time tablet-based resuscitation documentation by the team leader: evaluating documentation quality and clinical performance

Background

Precise and complete documentation of in-hospital cardiopulmonary resuscitations is important but data quality can be poor. In the present study, we investigated the effect of a tablet-based application for real-time resuscitation documentation used by the emergency team leader on documentation quality and clinical performance of the emergency team.

Methods

Senior anaesthesiologists either used the tablet-based application during the simulated resuscitation for documentation and also used the application for the final documentation or conducted the full documentation at the end of the scenario using the local hospital information system. The latter procedure represents the current local documentation method. All scenarios were video recorded. To assess the documentation, we compared the precision of intervention delivery times, documentation completeness, and final documentation time. To assess clinical performance, we compared adherence to guidelines for defibrillation and adrenaline administration, the no-flow fraction, and the time to first defibrillation.

Results

The results showed significant benefits for the tablet-based application compared to the hospital information system for precision of the intervention delivery times, the final documentation time, and the no-flow fraction. We observed no differences between the groups for documentation completeness, adherence to guidelines for defibrillation and adrenaline administration, and the time to first defibrillation.

Discussion

In the presented study, we observed that a tablet-based application can improve documentation data quality. Furthermore, we demonstrated that a well-designed application can be used in real-time by a member of the emergency team with possible beneficial effects on clinical performance.

Conclusion

The present evaluation confirms the advantage of tablet-based documentation tools and also shows that the application can be used by an active member of an emergency team without compromising clinical performance.

Documentation of Resuscitation Events

Resuscitation documentation assists health care professionals in trending patient status, determining what treatments may be most effective, and determining where opportunities for improvement may exist. An overview of what is known about resuscitation documentation is provided in this article, as are implications for future research related to documentation of resuscitation events. Use of the Utstein guidelines in determining essential elements of resuscitation documentation is also presented.

Automated speech recognition for time recording in out-of-hospital emergency medicine-an experimental approach

Precise documentation of medical treatment in emergency medical missions and for resuscitation is essential from a medical, legal and quality assurance point of view [Anästhesiologie und Intensivmedizin, 41 (2000) 737]. All conventional methods of time recording are either too inaccurate or elaborate for routine application. Automated speech recognition may offer a solution. A special erase programme for the documentation of all time events was developed. Standard speech recognition software (IBM ViaVoice 7.0) was adapted and installed on two different computer systems. One was a stationary PC (500MHz Pentium III, 128MB RAM, Soundblaster PCI 128 Soundcard, Win NT 4.0), the other was a mobile pen-PC that had already proven its value during emergency missions [Der Notarzt 16, p. 177] (Fujitsu Stylistic 2300, 230Mhz MMX Processor, 160MB RAM, embedded soundcard ESS 1879 chipset, Win98 2nd ed.). On both computers two different microphones were tested. One was a standard headset that came with the recognition software, the other was a small microphone (Lavalier-Kondensatormikrofon EM 116 from Vivanco), that could be attached to the operators collar. Seven women and 15 men spoke a text with 29 phrases to be recognised. Two emergency physicians tested the system in a simulated emergency setting using the collar microphone and the pen-PC with an analogue wireless connection. Overall recognition was best for the PC with a headset (89%) followed by the pen-PC with a headset (85%), the PC with a microphone (84%) and the pen-PC with a microphone (80%). Nevertheless, the difference was not statistically significant. Recognition became significantly worse (89.5% versus 82.3%, P<0.0001 ) when numbers had to be recognised. The gender of speaker and the number of words in a sentence had no influence. Average recognition in the simulated emergency setting was 75%. At no time did false recognition appear. Time recording with automated speech recognition seems to be possible in emergency medical missions. Although results show an average recognition of only 75%, it is possible that missing elements may be reconstructed more precisely. Future technology should integrate a secure wireless connection between microphone and mobile computer. The system could then prove its value for real out-of-hospital emergencies.

The ABCs of recording paediatric cardiac arrests

OBJECTIVE

To examine the quality and comprehensiveness of documentation in Paediatric 'cardiac arrests'.

DESIGN

Retrospective chart review.

SETTING

Tertiary care hospital wards, Paediatric Intensive Care and Accident and Emergency department.

SUBJECTS

41 children experiencing acute life-threatening events in hospital.

RESULTS

Overall documentation of details related to time, place and personnel was highly variable but generally present in over half of the cases reviewed. Data relating to specific drug-related and interventional therapies was insufficient, as was documentation of time intervals and consequent therapeutic decisions.

CONCLUSIONS

Documentation of critical resuscitation episodes in children is below recognised standards and this has potential quality of care and medicolegal implications. Current teaching needs to emphasise this essential aspect of clinical care from the earliest level of training.