Making the pediatric perioperative surgical home come to life by leveraging existing health information technology

State-of-the-art Dashboards on Clinical Indicator Data to Support Reflection on Practice: Scoping Review

Background

There is an increasing interest in using routinely collected eHealth data to support reflective practice and long-term professional learning. Studies have evaluated the impact of dashboards on clinician decision-making, task completion time, user satisfaction, and adherence to clinical guidelines.

Objective

This scoping review aims to summarize the literature on dashboards based on patient administrative, medical, and surgical data for clinicians to support reflective practice.

Methods

A scoping review was conducted using the Arksey and O’Malley framework. A search was conducted in 5 electronic databases (MEDLINE, Embase, Scopus, ACM Digital Library, and Web of Science) to identify studies that met the inclusion criteria. Study selection and characterization were performed by 2 independent reviewers (BB and CP). One reviewer extracted the data that were analyzed descriptively to map the available evidence.

Results

A total of 18 dashboards from 8 countries were assessed. Purposes for the dashboards were designed for performance improvement (10/18, 56%), to support quality and safety initiatives (6/18, 33%), and management and operations (4/18, 22%). Data visualizations were primarily designed for team use (12/18, 67%) rather than individual clinicians (4/18, 22%). Evaluation methods varied among asking the clinicians directly (11/18, 61%), observing user behavior through clinical indicators and use log data (14/18, 78%), and usability testing (4/18, 22%). The studies reported high scores on standard usability questionnaires, favorable surveys, and interview feedback. Improvements to underlying clinical indicators were observed in 78% (7/9) of the studies, whereas 22% (2/9) of the studies reported no significant changes in performance.

Conclusions

This scoping review maps the current literature landscape on dashboards based on routinely collected clinical indicator data. Although there were common data visualization techniques and clinical indicators used across studies, there was diversity in the design of the dashboards and their evaluation. There was a lack of detail regarding the design processes documented for reproducibility. We identified a lack of interface features to support clinicians in making sense of and reflecting on their personal performance data.

Implementing a Pediatric Perioperative Surgical Home Integrated Care Coordination Pathway for Laryngeal Cleft Repair

BACKGROUND

The Pediatric Perioperative Surgical Home (PPSH) model is an integrative care model designed to provide better patient care and value by shifting focus from the patient encounter level to the overarching surgical episode of care. So far, no PPSH model has targeted a complex airway disorder. It was hypothesized that the development of a PPSH for laryngeal cleft repair would reduce the high rates of postoperative resource utilization observed in this population.

METHODS

Institutional review board approval was obtained for the purpose of data collection and analysis. A multidisciplinary team of anesthesiologists, surgeons, nursing staff, information technology specialists, and finance administrators was gathered during the PPSH development phase. Standardized perioperative (preoperative, intraoperative, and postoperative) protocols were developed, with a focus on preoperative risk stratification. Patients presenting before surgery with ≥1 predefined medical comorbidity were triaged to the intensive care unit (ICU) postoperatively, while patients without severe systemic disease were triaged to a lower-acuity floor for overnight observation. The success of the PPSH protocol was defined by quality outcome and value measurements.

RESULTS

The PPSH initiative included 120 patients, and the pre-PPSH period included 115 patients who underwent laryngeal cleft repair before implementation of the new process. Patients in the pre-PPSH period were reviewed and classified as ICU candidates or lower acuity floor candidates had they presented in the post-PPSH period. Among the 79 patients in the pre-PPSH period who were identified as candidates for the lower-acuity floor transfer, 70 patients (89%) were transferred to the ICU (P < .001). Retrospective analysis concluded that 143 ICU bedded days could have been avoided in the pre-PPSH group by using PPSH risk stratification. Surgery duration (P = .034) and hospital length of stay (P = .015) were found to be slightly longer in the group of pre-PPSH observation unit candidates. Rates of 30-day unplanned readmissions to the hospital were not associated with the new PPSH initiative (P = .093). No patients in either group experienced emergent postoperative intubation or other expected complications. Total hospital costs were not lower for PPSH observation unit patients as compared to pre-PPSH observation unit candidates (difference = 8%; 95% confidence interval, -7% to 23%).

CONCLUSIONS

A well-defined preoperative screening protocol for patients undergoing laryngeal cleft repair can reduce postoperative ICU utilization without affecting patient safety. Further research is needed to see if these findings are applicable to other complex airway surgeries.