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Coelho F, Furtado L, Mendonça N, Soares H, Duarte H, Costeira C, Santos C, Sousa JP. Interventions to Minimize Medication Error by Nurses in Intensive Care: A Scoping Review Protocol. NURSING REPORTS 2023; 13:1040-1050. [PMID: 37606459 PMCID: PMC10443247 DOI: 10.3390/nursrep13030091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
Medication errors represent a concern for healthcare organizations due to their negative consequences. In the nursing context, these errors represent a threat to the quality of care and patient safety. Many factors have been identified as potential causes for these errors in intensive care units. A scoping review will be developed to identify interventions/strategies to minimize the occurrence of medication errors by nurses, considering the Joanna Briggs Institute (JBI) methodology. A search will be conducted in the EbscoHost (CINAHL Complete and MEDLINE), Embase and PubMed databases. Data analysis, extraction and synthesis will be carried out by two reviewers independently. This review will attempt to map which interventions are more specific to minimizing medication error by nurses in intensive care and to recognize which factors influence this type of error to mitigate practices that may lead to error. This protocol acts as the framework for a scoping review in the strategy to map the interventions and which factors contribute to the medication error by intensive care nurses. This study was prospectively registered with the Open Science Framework on 21 April 2023 with registration number DOI 10.17605/OSF.IO/94KH3.
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Affiliation(s)
- Fábio Coelho
- Department of Nursing, Mental Health, and Gerontology, School of Health, University of the Azores, 9700-042 Angra do Heroísmo, Portugal; (L.F.); (H.S.)
| | - Luís Furtado
- Department of Nursing, Mental Health, and Gerontology, School of Health, University of the Azores, 9700-042 Angra do Heroísmo, Portugal; (L.F.); (H.S.)
| | - Natália Mendonça
- Flores Island Healthcare Unit, 9960-430 Flores Island, Portugal;
| | - Hélia Soares
- Department of Nursing, Mental Health, and Gerontology, School of Health, University of the Azores, 9700-042 Angra do Heroísmo, Portugal; (L.F.); (H.S.)
| | - Hugo Duarte
- Center for Innovative Care and Health Technology—ciTechCare, School of Health Sciences, Polytechnic of Leiria, 2411-090 Leiria, Portugal; (H.D.); (C.C.); (C.S.); (J.P.S.)
| | - Cristina Costeira
- Center for Innovative Care and Health Technology—ciTechCare, School of Health Sciences, Polytechnic of Leiria, 2411-090 Leiria, Portugal; (H.D.); (C.C.); (C.S.); (J.P.S.)
| | - Cátia Santos
- Center for Innovative Care and Health Technology—ciTechCare, School of Health Sciences, Polytechnic of Leiria, 2411-090 Leiria, Portugal; (H.D.); (C.C.); (C.S.); (J.P.S.)
| | - Joana Pereira Sousa
- Center for Innovative Care and Health Technology—ciTechCare, School of Health Sciences, Polytechnic of Leiria, 2411-090 Leiria, Portugal; (H.D.); (C.C.); (C.S.); (J.P.S.)
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Mastrianni A, Sarcevic A, Hu A, Almengor L, Tempel P, Gao S, Burd RS. Transitioning Cognitive Aids into Decision Support Platforms: Requirements and Design Guidelines. ACM TRANSACTIONS ON COMPUTER-HUMAN INTERACTION : A PUBLICATION OF THE ASSOCIATION FOR COMPUTING MACHINERY 2023; 30:41. [PMID: 37694216 PMCID: PMC10489246 DOI: 10.1145/3582431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 12/16/2022] [Indexed: 09/12/2023]
Abstract
Digital cognitive aids have the potential to serve as clinical decision support platforms, triggering alerts about process delays and recommending interventions. In this mixed-methods study, we examined how a digital checklist for pediatric trauma resuscitation could trigger decision support alerts and recommendations. We identified two criteria that cognitive aids must satisfy to support these alerts: (1) context information must be entered in a timely, accurate, and standardized manner, and (2) task status must be accurately documented. Using co-design sessions and near-live simulations, we created two checklist features to satisfy these criteria: a form for entering the pre-hospital information and a progress slider for documenting the progression of a multi-step task. We evaluated these two features in the wild, contributing guidelines for designing these features on cognitive aids to support alerts and recommendations in time- and safety-critical scenarios.
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Affiliation(s)
- Angela Mastrianni
- College of Computing and Informatics, Drexel University, Philadelphia, USA
| | | | - Allison Hu
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, D.C., USA
| | - Lynn Almengor
- College of Computing and Informatics, Drexel University, Philadelphia, USA
| | - Peyton Tempel
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, D.C., USA
| | - Sarah Gao
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, D.C., USA
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, D.C., USA
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Kodeboina M, Piayda K, Jenniskens I, Vyas P, Chen S, Pesigan RJ, Ferko N, Patel BP, Dobrin A, Habib J, Franke J. Challenges and Burdens in the Coronary Artery Disease Care Pathway for Patients Undergoing Percutaneous Coronary Intervention: A Contemporary Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095633. [PMID: 37174152 PMCID: PMC10177939 DOI: 10.3390/ijerph20095633] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/24/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
Clinical and economic burdens exist within the coronary artery disease (CAD) care pathway despite advances in diagnosis and treatment and the increasing utilization of percutaneous coronary intervention (PCI). However, research presenting a comprehensive assessment of the challenges across this pathway is scarce. This contemporary review identifies relevant studies related to inefficiencies in the diagnosis, treatment, and management of CAD, including clinician, patient, and economic burdens. Studies demonstrating the benefits of integration and automation within the catheterization laboratory and across the CAD care pathway were also included. Most studies were published in the last 5-10 years and focused on North America and Europe. The review demonstrated multiple potentially avoidable inefficiencies, with a focus on access, appropriate use, conduct, and follow-up related to PCI. Inefficiencies included misdiagnosis, delays in emergency care, suboptimal testing, longer procedure times, risk of recurrent cardiac events, incomplete treatment, and challenges accessing and adhering to post-acute care. Across the CAD pathway, this review revealed that high clinician burnout, complex technologies, radiation, and contrast media exposure, amongst others, negatively impact workflow and patient care. Potential solutions include greater integration and interoperability between technologies and systems, improved standardization, and increased automation to reduce burdens in CAD and improve patient outcomes.
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Affiliation(s)
- Monika Kodeboina
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
- Clinic for Internal Medicine and Cardiology, Marien Hospital, 52066 Aachen, Germany
| | - Kerstin Piayda
- Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
- Department of Cardiology and Vascular Medicine, Medical Faculty, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | | | | | | | | | | | | | | | | | - Jennifer Franke
- Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
- Philips Chief Medical Office, 22335 Hamburg, Germany
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Maraş G, Ceyhan Ö, Delen N. Intensive care nurses' knowledge and use of a nursing checklist: A cross-sectional survey. J Nurs Manag 2022; 30:4442-4451. [PMID: 36257924 DOI: 10.1111/jonm.13874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/03/2022] [Accepted: 09/25/2022] [Indexed: 12/30/2022]
Abstract
AIM This descriptive study was conducted to determine the awareness of nurses working in intensive care units about the daily patient checklist. BACKGROUND Checklists are used in the daily follow-up and evaluation of patients admitted to the intensive care unit. METHOD The research was carried out with 180 nurses through the social media account of the Turkish Intensive Care Specialists Association Nurse Commission between July 2021 and March 2022. Data were collected with a descriptive information form and intensive care unit daily patient checklist. Necessary permissions were obtained before the study. RESULTS Among nurses, 45.0% of them got 15 full points from the Checklist. Moreover, 81.1% of the nurses stated that they knew that a checklist should be used to help eliminate the deficiencies of daily care and treatment in the intensive care unit, while 66.7% stated that they used a checklist. It was determined that nurses knew the most about parameters 'Check the daily infection parameters', 'Glycaemic control', 'Therapy', and the least about parameters 'Thromboprophylaxis', 'Ulcer prevention', 'Hypo-hyper delirium' and 'Use a daily checklist'. CONCLUSION It was determined that the level of awareness of intensive care unit nurses about some parameters that should be followed daily for patient care was low. IMPLICATIONS FOR NURSING MANAGEMENT Checklists can be used as a guide for health care professionals in the routine daily evaluation of intensive care unit patients. It is thought that these reminder abbreviations will provide efficiency in preventing the disruption of applications, reducing medical errors, reducing mortality and morbidity, and cost.
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Affiliation(s)
- Gülseren Maraş
- Faculty of Health Sciences, Surgery Nursing, Erciyes University, Kayseri, Turkey
| | - Özlem Ceyhan
- Faculty of Health Sciences, Internal Medicine Nursing, Erciyes University, Kayseri, Turkey
| | - Nuray Delen
- President of Turkish Internal and Surgical Sciences Intensive Care Association Nursing Commission, Ankara, Turkey
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Perera GN, Hey LA, Chen KB, Morello MJ, McConnell BM, Ivy JS. Checklists in Healthcare: Operational Improvement of Standards using Safety Engineering - Project CHOISSE - A framework for evaluating the effects of checklists on surgical team culture. APPLIED ERGONOMICS 2022; 103:103786. [PMID: 35617733 DOI: 10.1016/j.apergo.2022.103786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 03/10/2022] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
The CHOISSE multi-stage framework for evaluating the effects of electronic checklist applications (e-checklists) on surgical team members' perception of their roles, performance, communication, and understanding of checklists is introduced via a pilot study. A prospective interventional cohort study design was piloted to assess the effectiveness of the framework and the sociotechnical effects of the e-checklist. A Delphi process was used to design the stages of the framework based on literature and expert consensus. The CHOISSE framework was applied to guide the implementation and evaluation of e-checklists on team culture for ten pilot teams across the US over a 24-week period. The pilot results revealed more engagement by surgeons than non-surgeons, and significant increases in surgeons' perception of communication and engagement during surgery with a small sample. Mixed methods analysis of the data and lessons learned were used to identify iterative improvements to the CHOISSE framework and to inform future studies.
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Affiliation(s)
- Gimantha N Perera
- Department of Industrial and Systems Engineering, North Carolina State University, NC, USA.
| | - Lloyd A Hey
- Hey Clinic for Scoliosis and Spine Care, Duke Raleigh Hospital, NC, USA
| | - Karen B Chen
- Department of Industrial and Systems Engineering, North Carolina State University, NC, USA
| | - Madeline J Morello
- Department of Industrial and Systems Engineering, North Carolina State University, NC, USA
| | - Brandon M McConnell
- Department of Industrial and Systems Engineering, North Carolina State University, NC, USA; Center for Additive Manufacturing and Logistics, North Carolina State University, Raleigh, NC, USA
| | - Julie S Ivy
- Department of Industrial and Systems Engineering, North Carolina State University, NC, USA
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Allum L, Apps C, Pattison N, Connolly B, Rose L. Informing the standardising of care for prolonged stay patients in the ICU: A scoping review of quality improvement tools. Intensive Crit Care Nurs 2022; 73:103302. [PMID: 35931596 DOI: 10.1016/j.iccn.2022.103302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To inform design of quality improvement (QI) tools specific to patients with prolonged intensive care unit (ICU) stay, we determined characteristics (format/content), development, implementation, and outcomes of published multi-component QI tools used in ICU irrespective of length of stay. RESEARCH METHODOLOGY Scoping review searching electronic databases, trial registries and grey literature (January 2000 to January 2022). RESULTS We screened 58,378 citations, identifying 96 studies. All tools were designed for use commencing at ICU admission except 3 tools implemented at 3, 5 or 14 days. We identified 32 studies of locally developed checklists, 28 goal setting/structured communication templates, 23 care bundles, and 9 studies of mixed format tools. Most (43 %) tools were designed for use during rounds, fewer tools were designed for use throughout the ICU day (27 %) or stay (9 %). Most studies (55 %) reported process objectives i.e., improving communication, care standardisation, or rounding efficiency. Most common clinical processes QI tools were used to standardise were sedation (62, 65 %), ventilation and weaning (55, 57 %), and analgesia management (58, 60 %). 44 studies reported the effect of the tool on patient outcomes. Of these, only two identified a negative effect - increased ICU length of stay and increased ICU days with pain and delirium. CONCLUSION Although we identified numerous QI tools for use in ICU settings, few were designed to specifically address actionable processes of care relevant to the unique needs of prolonged ICU stay patients. Tools that address these needs are urgently required. SYSTEMATIC REVIEW REGISTRATION The review protocol is registered on the Open Science Framework, https://osf.io/, DOI 10.17605/OSF.IO/Z8MRE.
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Affiliation(s)
- Laura Allum
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK; Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK.
| | - Chloe Apps
- Critical Care Research Group and Physiotherapy Department, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Rd, London SE1 7EH, UK.
| | - Natalie Pattison
- University of Hertfordshire, College Lane, Hatfield AL109AB, UK; East & North Herts NHS Trust, Coreys Mill Lane, Stevenage SG14AB, UK.
| | - Bronwen Connolly
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Centre for Human and Applied Physiological Sciences, King's College London, UK; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK; Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK.
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Pook M, Zamir N, McDonald E, Fox-Robichaud A. Chlorhexidine (di)gluconate locking device for central line infection prevention in intensive care unit patients: a multi-unit, pilot randomized controlled trial. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S36-S46. [PMID: 35856588 DOI: 10.12968/bjon.2022.31.14.s36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Intensive care unit (ICU) patients are at risk for central line-associated bloodstream infection (CLABSI) with significant attributable mortality and increased hospital length of stay, readmissions, and costs. Chlorhexidine (di)gluconate (CHG) is used as a disinfectant for central line insertion; however, the feasibility and efficacy of using CHG as a locking solution is unknown. METHODS Patients with a central venous access device (CVAD) in situ were randomized to standard care or a CHG lock solution (CHGLS) within 72 hours of ICU admission. The CHG solution was instilled in the lumen of venous catheters not actively infusing. CVAD blood cultures were taken at baseline and every 48 hours. The primary outcome was feasibility including recruitment rate, consent rate, protocol adherence, and staff uptake. Secondary outcomes included CVAD colonization, bacteraemia, and clinical endpoints. RESULTS Of 3,848 patients screened, 122 were eligible for the study and consent was obtained from 82.0% of the patients or substitute decision makers approached. Fifty participants were allocated to each group. Tracking logs indicated that the CHGLS was used per protocol 408 times. Most nurses felt comfortable using the CHGLS. The proportion of central line colonization was significantly higher in the standard care group with 40 (29%) versus 26 (18.7%) in the CHGLS group (P=0.009). CONCLUSIONS Using a device that delivers CHG into CVADs was feasible in the ICU. Findings from this trial will inform a full-scale randomized controlled trial and provide preliminary data on the effectiveness of CHGLS. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03309137, registered on October 13, 2017.
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Lipatov K, Daniels CE, Park JG, Elmer J, Hanson AC, Madsen BE, Clements CM, Gajic O, Pickering BW, Herasevich V. Implementation and evaluation of sepsis surveillance and decision support in medical ICU and emergency department. Am J Emerg Med 2021; 51:378-383. [PMID: 34823194 DOI: 10.1016/j.ajem.2021.09.086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To improve the timely diagnosis and treatment of sepsis many institutions implemented automated sepsis alerts. Poor specificity, time delays, and a lack of actionable information lead to limited adoption by bedside clinicians and no change in practice or clinical outcomes. We aimed to compare sepsis care compliance before and after a multi-year implementation of a sepsis surveillance coupled with decision support in a tertiary care center. DESIGN Single center before and after study. SETTING Large academic Medical Intensive Care Unit (MICU) and Emergency Department (ED). POPULATION Patients 18 years of age or older admitted to *** Hospital MICU and ED from 09/4/2011 to 05/01/2018 with severe sepsis or septic shock. INTERVENTIONS Electronic medical record-based sepsis surveillance system augmented by clinical decision support and completion feedback. MEASUREMENTS AND MAIN RESULTS There were 1950 patients admitted to the MICU with the diagnosis of severe sepsis or septic shock during the study period. The baseline characteristics were similar before (N = 854) and after (N = 1096) implementation of sepsis surveillance. The performance of the alert was modest with a sensitivity of 79.9%, specificity of 76.9%, positive predictive value (PPV) 27.9%, and negative predictive value (NPV) 97.2%. There were 3424 unique alerts and 1131 confirmed sepsis patients after the sniffer implementation. During the study period average care bundle compliance was higher; however after taking into account improvements in compliance leading up to the intervention, there was no association between intervention and improved care bundle compliance (Odds ratio: 1.16; 95% CI: 0.71 to 1.89; p-value 0.554). Similarly, the intervention was not associated with improvement in hospital mortality (Odds ratio: 1.55; 95% CI: 0.95 to 2.52; p-value: 0.078). CONCLUSIONS A sepsis surveillance system incorporating decision support or completion feedback was not associated with improved sepsis care and patient outcomes.
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Affiliation(s)
- Kirill Lipatov
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Craig E Daniels
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - John G Park
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jennifer Elmer
- Department of Nursing, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Andrew C Hanson
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Bo E Madsen
- Department of Emergency Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Casey M Clements
- Department of Emergency Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Ognjen Gajic
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Mastrianni A, Sarcevic A, Chung LS, Zakeri I, Alberto EC, Milestone ZP, Burd RS, Marsic I. Designing Interactive Alerts to Improve Recognition of Critical Events in Medical Emergencies. DIS. DESIGNING INTERACTIVE SYSTEMS (CONFERENCE) 2021; 2021:864-878. [PMID: 35330919 PMCID: PMC8941664 DOI: 10.1145/3461778.3462051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Vital sign values during medical emergencies can help clinicians recognize and treat patients with life-threatening injuries. Identifying abnormal vital signs, however, is frequently delayed and the values may not be documented at all. In this mixed-methods study, we designed and evaluated a two-phased visual alert approach for a digital checklist in trauma resuscitation that informs users about undocumented vital signs. Using an interrupted time series analysis, we compared documentation in the periods before (two years) and after (four months) the introduction of the alerts. We found that introducing alerts led to an increase in documentation throughout the post-intervention period, with clinicians documenting vital signs earlier. Interviews with users and video review of cases showed that alerts were ineffective when clinicians engaged less with the checklist or set the checklist down to perform another activity. From these findings, we discuss approaches to designing alerts for dynamic team-based settings.
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Young AL, Doughty CB, Williamson KC, Won SK, Rus MC, Villarreal NN, Camp EA, Lemke DS. Workload of learners during simulated paediatric cardiopulmonary resuscitation. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:338-344. [PMID: 35515742 PMCID: PMC8936742 DOI: 10.1136/bmjstel-2020-000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/03/2022]
Abstract
IntroductionLearner workload during simulated team-based resuscitations is not well understood. In this descriptive study, we measured the workload of learners in different team roles during simulated paediatric cardiopulmonary resuscitation.MethodsPaediatric emergency nurses and paediatric and emergency medicine residents formed teams of four to eight and randomised into roles to participate in simulation-based, paediatric resuscitation. Participant workload was measured using the NASA Task Load Index, which provides an average workload score (from 0 to 100) across six subscores: mental demand, physical demand, temporal demand, performance, frustration and mental effort. Workload is considered low if less than 40, moderate if between 40 and 60 and high if greater than 60.ResultsThere were 210 participants representing 40 simulation teams. 138 residents (66%) and 72 nurses (34%) participated. Team lead reported the highest workload at 65.2±10.0 (p=0.001), while the airway reported the lowest at 53.9±10.8 (p=0.001); team lead had higher scores for all subscores except physical demand. Team lead reported the highest mental demand (p<0.001), while airway reported the lowest. Cardiopulmonary resuscitation coach and first responder reported the highest physical demands (p<0.001), while team lead and nurse recorder reported the lowest (p<0.001).ConclusionsWorkload for learners in paediatric simulated resuscitation teams was moderate to high and varied significantly based on team role. Composition of workload varied significantly by team role. Measuring learner workload during simulated resuscitations allows improved processes and choreography to optimise workload distribution.
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Affiliation(s)
- Ann L Young
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Cara B Doughty
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Kaitlin C Williamson
- Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sharon K Won
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Marideth C Rus
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Nadia N Villarreal
- Pediatric Emergency Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Elizabeth A Camp
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Daniel S Lemke
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
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De Bie Dekker AJR, Dijkmans JJ, Todorovac N, Hibbs R, Boe Krarup K, Bouwman AR, Barach P, Fløjstrup M, Cooksley T, Kellett J, Bindels AJGH, Korsten HHM, Brabrand M, Subbe CP. Testing the effects of checklists on team behaviour during emergencies on general wards: An observational study using high-fidelity simulation. Resuscitation 2020; 157:3-12. [PMID: 33027620 DOI: 10.1016/j.resuscitation.2020.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Clinical teams struggle on general wards with acute management of deteriorating patients. We hypothesized that the Crisis Checklist App, a mobile application containing checklists tailored to crisis-management, can improve teamwork and acute care management. METHODS A before-and-after study was undertaken in high-fidelity simulation centres in the Netherlands, Denmark and United Kingdom. Clinical teams completed three scenarios with a deteriorating patient without checklists followed by three scenarios using the Crisis Checklist App. Teamwork performance as the primary outcome was assessed by the Mayo High Performance Teamwork scale. The secondary outcomes were the time required to complete all predefined safety-critical steps, percentage of omitted safety-critical steps, effects on other non-technical skills, and users' self-assessments. Linear mixed models and a non-parametric survival test were conducted to assess these outcomes. RESULTS 32 teams completed 188 scenarios. The Mayo High Performance Teamwork scale mean scores improved to 23.4 out of 32 (95% CI: 22.4-24.3) with the Crisis Checklist App compared to 21.4 (20.4-22.3) with local standard of care. The mean difference was 1.97 (1.34-2.6; p < 0.001). Teams that used the checklists were able to complete all safety-critical steps of a scenario in more simulations (40/95 vs 21/93 scenarios) and these steps were completed faster (stratified log-rank test χ2 = 8.0; p = 0.005). The self-assessments of the observers and users showed favourable effects after checklist usage for other non-technical skills including situational awareness, decision making, task management and communication. CONCLUSIONS Implementation of a novel mobile crisis checklist application among clinical teams was associated in a simulated general ward setting with improved teamwork performance, and a higher and faster completion rate of predetermined safety-critical steps.
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Affiliation(s)
- A J R De Bie Dekker
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - J J Dijkmans
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - N Todorovac
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - R Hibbs
- Integral Business Support Ltd, Wrexham, United Kingdom
| | - K Boe Krarup
- Department of Anesthesiology, Odense University Hospital, Odense, Denmark
| | - A R Bouwman
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - P Barach
- Department of Anesthesiology and Critical care, Wayne State University School of Medicine, Detroit; Jefferson College of Population Health, PA, USA
| | - M Fløjstrup
- Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - T Cooksley
- Department of Acute and Internal Medicine, The Christie Hospital, Manchester, United Kingdom
| | - J Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - A J G H Bindels
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - H H M Korsten
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - M Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark; Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - C P Subbe
- Department of Acute Medicine, Ysbyty Gwynedd and Bangor University, Bangor, United Kingdom
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12
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Calzoni L, Clermont G, Cooper GF, Visweswaran S, Hochheiser H. Graphical Presentations of Clinical Data in a Learning Electronic Medical Record. Appl Clin Inform 2020; 11:680-691. [PMID: 33058103 PMCID: PMC7560537 DOI: 10.1055/s-0040-1709707] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Complex electronic medical records (EMRs) presenting large amounts of data create risks of cognitive overload. We are designing a Learning EMR (LEMR) system that utilizes models of intensive care unit (ICU) physicians' data access patterns to identify and then highlight the most relevant data for each patient. OBJECTIVES We used insights from literature and feedback from potential users to inform the design of an EMR display capable of highlighting relevant information. METHODS We used a review of relevant literature to guide the design of preliminary paper prototypes of the LEMR user interface. We observed five ICU physicians using their current EMR systems in preparation for morning rounds. Participants were interviewed and asked to explain their interactions and challenges with the EMR systems. Findings informed the revision of our prototypes. Finally, we conducted a focus group with five ICU physicians to elicit feedback on our designs and to generate ideas for our final prototypes using participatory design methods. RESULTS Participating physicians expressed support for the LEMR system. Identified design requirements included the display of data essential for every patient together with diagnosis-specific data and new or significantly changed information. Respondents expressed preferences for fishbones to organize labs, mouseovers to access additional details, and unobtrusive alerts minimizing color-coding. To address the concern about possible physician overreliance on highlighting, participants suggested that non-highlighted data should remain accessible. Study findings led to revised prototypes, which will inform the development of a functional user interface. CONCLUSION In the feedback we received, physicians supported pursuing the concept of a LEMR system. By introducing novel ways to support physicians' cognitive abilities, such a system has the potential to enhance physician EMR use and lead to better patient outcomes. Future plans include laboratory studies of both the utility of the proposed designs on decision-making, and the possible impact of any automation bias.
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Affiliation(s)
- Luca Calzoni
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Gilles Clermont
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Gregory F Cooper
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Harry Hochheiser
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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13
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Curtis K, Qian S, Yu P, White J, Ruperto K, Balzer S, Munroe B. Does electronic medical record redesign increase screening of risk for pressure injury, falls and substance use in the Emergency Department? An implementation evaluation. Australas Emerg Care 2020; 24:20-27. [PMID: 32376117 DOI: 10.1016/j.auec.2020.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Following the provision of urgent care, screening for risks known to impact patient outcomes is an extension of safe emergency nursing care, in particular for falls, pressure injury and substance use. Screening is a process that primarily aims to identify people at increased risk for specific complications. This study aimed to describe and evaluate the implementation of a consolidated electronic checklist on the screening completion rates for falls, pressure injury and substance use in a regional health district. METHODS This pre-post study used emergency data from four Emergency Departments (EDs) in southern NSW, Australia between November 2016 and February 2019. Patient characteristics, triage category, discharge diagnosis, arrival date and time, screening completion date and time and treatment location were extracted. Descriptive statistics were used to describe the characteristics of the presentations. Z test with adjusted p-values using Bonferroni Correction method was used to compare the characteristics of the presentations and the rates of screening completion. The Theoretical Domains Framework was used to identify any deficits in the implementation. RESULTS There were 33,561 patients in the pre and 35,807 in the post group. There were no differences in patient characteristics between the two groups. The mean emergency department (ED) length of stay was unchanged (490.5min pre vs 489.9min post). The proportion of patients who had all three screens completed increased from 1.3% to 5.5% (p<0.001). Pressure injury risk screening increased from 46.6% (pre) to 53.1% (post) (p<0.001) as did substance use screening (1.7% vs 12.4%, p<0.001). Screening was strongly associated to which hospital the patient was admitted, their age and ED length of stay. Of the 51 mapped intervention functions, 20 (39%) were used in the implementation. CONCLUSIONS The introduction of a consolidated electronic checklist for use by emergency nurses to complete fall, pressure injury and substance use screening resulted in an overall increase in risk screening. However screening rates remained poor. Implementation that considers the capability, opportunity and motivation of those that need to alter their behaviour would likely improve the overall compliance.
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Affiliation(s)
- Kate Curtis
- Emergency Services, Illawarra Shoalhaven Local Health District, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia; Illawarra Health and Medical Research Institute, Australia; Faculty of Science, Medicine and Health, University of Wollongong, Australia.
| | - Siyu Qian
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Australia; Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Australia
| | - Janet White
- eMR Application Support-FirstNet, Health ICT, NSW Health, Australia
| | - Kate Ruperto
- Emergency Services, Illawarra Shoalhaven Local Health District, Australia
| | - Sharyn Balzer
- Emergency Department, Shoalhaven District Memorial Hospital, Illawarra Shoalhaven Local Health District, Australia
| | - Belinda Munroe
- Emergency Services, Illawarra Shoalhaven Local Health District, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia
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Mastrianni A, Kulp L, Mapelli E, Sarcevic A. Understanding Digital Checklist Use Through Team Communication. EXTENDED ABSTRACTS ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2020; 2020. [PMID: 32747878 DOI: 10.1145/3334480.3382817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introducing technology support in a complex, team-based work setting requires a study of teamwork effects on technology use. In this paper, we present our initial analysis of team communications in a trauma resuscitation setting, where we deployed a digital checklist to support trauma team leaders in guiding patient care. By analyzing speech transcripts, checklist interaction logs, and videos of 15 resuscitations, we identified several tensions that arose from the use of a checklist in a team-based process with multi-step tasks. The tensions included incorrect markings of in-progress tasks as completed, failure to mark completed tasks due to missed communications, failure to record planned tasks, and difficulties in recording dynamic values. From these findings, we discuss design implications for checklist design for dynamic, team-based activities.
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Affiliation(s)
| | - Leah Kulp
- Drexel University, Philadelphia, PA, USA
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15
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Jelacic S, Bowdle A, Nair BG, Togashi K, Boorman DJ, Cain KC, Lang JD, Dellinger EP. Aviation-Style Computerized Surgical Safety Checklist Displayed on a Large Screen and Operated by the Anesthesia Provider Improves Checklist Performance. Anesth Analg 2020; 130:382-390. [PMID: 31306243 DOI: 10.1213/ane.0000000000004328] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Many hospitals have implemented surgical safety checklists based on the World Health Organization surgical safety checklist, which was associated with improved outcomes. However, the execution of the checklists is frequently incomplete. We reasoned that aviation-style computerized checklist displayed onto large, centrally located screen and operated by the anesthesia provider would improve the performance of surgical safety checklist. METHODS We performed a prospective before and after observational study to evaluate the effect of a computerized surgical safety checklist system on checklist performance. We created checklist software and translated our 4-part surgical safety checklist from wall poster into an aviation-style computerized format displayed onto a large, centrally located screen and operated by the anesthesia provider. Direct observers recorded performance of the first part of the surgical safety checklist that was initiated before anesthetic induction, including completion of each checklist item, provider participation and distraction level, resistance to use of the checklist, and the time required for checklist completion before and after checklist system implementation. We compared trends of the proportions of cases with 100% surgical safety checklist completion over time between pre- and postintervention periods and assessed for a jump at the start of intervention using segmented logistic regression model while controlling for potential confounding variables. RESULTS A total of 671 cases were observed before and 547 cases were observed after implementation of the computerized surgical safety checklist system. The proportion of cases in which all of the items of the surgical safety checklist were completed significantly increased from 2.1% to 86.3% after the computerized checklist system implementation (P < .001). Before computerized checklist system implementation, 488 of 671 (72.7%) cases had <75% of checklist items completed, whereas after a computerized checklist system implementation, only 3 of 547 (0.5%) cases had <75% of checklist items completed. CONCLUSIONS The implementation of a computerized surgical safety checklist system resulted in an improvement in checklist performance.
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Affiliation(s)
- Srdjan Jelacic
- From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Andrew Bowdle
- From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Bala G Nair
- From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Kei Togashi
- From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Daniel J Boorman
- Boeing Test and Evaluation, The Boeing Company, Seattle, Washington
| | - Kevin C Cain
- Office of Nursing Research and Department of Biostatistics
| | - John D Lang
- From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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Eltaybani S, Abdelwareth M, Abou-Zeid NA, Ahmed N. Recommendations to prevent nursing errors: Content analysis of semi-structured interviews with intensive care unit nurses in a developing country. J Nurs Manag 2020; 28:690-698. [PMID: 32104934 DOI: 10.1111/jonm.12985] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/31/2020] [Accepted: 02/25/2020] [Indexed: 01/04/2023]
Abstract
AIM To elicit intensive care unit (ICU) nurses' recommendations to prevent nursing errors. BACKGROUND Errors are usually induced by faulty systems, and managers play a key role in building a safe health care system. METHOD A qualitative research design was used. Semi-structured interviews with 112 Egyptian ICU nurses were conducted, and responses were analysed using qualitative content analysis. RESULTS Responses from 108 nurses were analysed. Six themes of recommendations were identified: improvement and better organisation of resources, policy modification, education and training, likeness minimization, use of technology and work environment changes. CONCLUSION Nurses' recommendations reflect the poor-resource context in developing countries. Several recommendations, however, are relatively cheap to implement strategies. IMPLICATIONS FOR NURSING MANAGEMENT All reported recommendations are organisational issues. Improvement and better organisation of human and non-human resources is a priority issue to prevent or minimize nursing errors. Policy modification, education and training, and likeness minimization are relatively cheap, easy-to-implement strategies to tackle the occurrence of nursing errors in developing countries. Staff nurses should be actively involved in policy reform. Patient safety education should be supported by adopting modern technology and work environment reform.
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Affiliation(s)
- Sameh Eltaybani
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
- Department of Palliative Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mona Abdelwareth
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Nesreen A Abou-Zeid
- Department of Medical-Surgical Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
- College of Nursing, Princess Nourah University, Riyadh, Saudi Arabia
| | - Nadia Ahmed
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
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Anderson C, Tocchi C, Morrison L, Rackley C. A Smart-Phrase to Improve Documentation of Supportive Measures for Idiopathic Pulmonary Fibrosis. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Lemkin DL, Stryckman B, Klein JE, Custer JW, Bame W, Maranda L, Wood KE, Paulson C, Dezman ZDW. Integrating a safety smart list into the electronic health record decreases intensive care unit length of stay and cost. J Crit Care 2019; 57:246-252. [PMID: 31911086 DOI: 10.1016/j.jcrc.2019.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/28/2019] [Accepted: 09/16/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To measure how an integrated smartlist developed for critically ill patients would change intensive care units (ICUs) length of stay (LOS), mortality, and charges. MATERIALS AND METHODS Propensity-score analysis of adult patients admitted to one of 14 surgical and medical ICUs between June 2017 and May 2018. The smart list aimed to certain preventative measures for all critical patients (e.g., removing unneeded catheters, starting thromboembolic prophylaxis, etc.) and was integrated into the electronic health record workflows at the hospitals under study. RESULTS During the study period, 11,979 patients were treated in the 14 participating ICUs by 518 unique providers. Patients who had the smart list used during ≥60% of their ICU stay (N = 432 patients, 3.6%) were significantly more likely to have a shorter ICU LOS (HR = 1.20, 95% CI:1.0 to 1.4, p = 0.015) with an average decrease of -$1218 (95% CI: -$1830 to -$607, P < 0.001) in the amount charged per day. The intervention cohort had fewer average ventilator days (3.05 vent days, SD = 2.55) compared to propensity score matched controls (3.99, SD = 4.68, p = 0.015), but no changes in mortality (16.7% vs 16.0%, p = 0.78). CONCLUSIONS An integrated smart list shortened LOS and lowered charges in a diverse cohort of critically ill patients.
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Affiliation(s)
- Daniel L Lemkin
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Benoit Stryckman
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joel E Klein
- University of Maryland Medical System, Baltimore, MD, USA
| | - Jason W Custer
- Division of Pediatric Critical Care, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William Bame
- Data & Analytics, University of Maryland Medical System Baltimore, MD, USA
| | - Louise Maranda
- Department of Quantitative Sciences, University of Massachusetts, Worcester, MA, USA
| | - Kenneth E Wood
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Courtney Paulson
- Department of Decision, Operations, and Information Technologies, University of Maryland Robert H. Smith School of Business, College Park, MD, USA
| | - Zachary D W Dezman
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
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Sirvent JM, Cordon C, Cuenca S, Fuster C, Lorencio C, Ortiz P. Application, verification and correction from an elaborate checklist with some of the recommendations («do and do not do») of the SEMICYUC working groups. Med Intensiva 2019; 45:88-95. [PMID: 31477342 DOI: 10.1016/j.medin.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/08/2019] [Accepted: 07/15/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Based on some of the recommendations of the SEMICYUC working groups, we developed a checklist and applied it in 2 periods, analyzing their behavior as a tool for improving safety. DESIGN A comparative pre- and post-intervention longitudinal study was carried out. SETTING The Intensive Care Unit (ICU) of a 400-bed university hospital. PATIENTS Random cases series in 2 periods separated by 6 months. INTERVENTIONS We developed a checklist with 24 selected indicators that were randomly applied to 50 patients. Verification was conducted by a professional not related to care (prompter). We analyzed the results and compliance index and carried out corrective measures with training. With 6 months of preparation, we again applied the random checklist to 50 patients (post-intervention period) and compared the compliance indexes between the two timepoints. RESULTS There were no differences in demographic characteristics or evolution between the periods. The compliance index at baseline was 0.86±0.12 versus 0.91±0.52 in the post-intervention period (P=.023). An acceptable compliance index was obtained with the 24 indicators, though at baseline the compliance index was<0.85 for 5 recommendations. These detected non-compliances were worked upon through training in the second phase of the study. The post-intervention checklist evidenced improvement in compliance with the recommendations. CONCLUSIONS The checklist used to assess compliance with a selection of recommendations of the SEMICYUC applied and moderated by a prompter was seen to be a useful instrument allowing us to identify points for improvement in the management of Intensive Care Unit patients, increasing the quality and safety of care.
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Affiliation(s)
- J-M Sirvent
- Servicio de Medicina Intensiva (UCI), Hospital Universitario de Girona Doctor Josep Trueta, Girona, España.
| | - C Cordon
- Servicio de Medicina Intensiva (UCI), Hospital Universitario de Girona Doctor Josep Trueta, Girona, España
| | - S Cuenca
- Servicio de Medicina Intensiva (UCI), Hospital Universitario de Girona Doctor Josep Trueta, Girona, España
| | - C Fuster
- Servicio de Medicina Intensiva (UCI), Hospital Universitario de Girona Doctor Josep Trueta, Girona, España
| | - C Lorencio
- Servicio de Medicina Intensiva (UCI), Hospital Universitario de Girona Doctor Josep Trueta, Girona, España
| | - P Ortiz
- Servicio de Medicina Intensiva (UCI), Hospital Universitario de Girona Doctor Josep Trueta, Girona, España
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Kulp L, Sarcevic A, Cheng M, Zheng Y, Burd RS. Comparing the Effects of Paper and Digital Checklists on Team Performance in Time-Critical Work. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2019; 2019. [PMID: 31633126 DOI: 10.1145/3290605.3300777] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This mixed-methods study examines the effects of a tablet-based checklist system on team performance during a dynamic and safety-critical process of trauma resuscitation. We compared team performance from 47 resuscitations that used a paper checklist to that from 47 cases with a digital checklist to determine if digitizing a checklist led to improvements in task completion rates and in how fast the tasks were initiated for 18 most critical assessment and treatment tasks. We also compared if the checklist compliance increased with the digital design. We found that using the digital checklist led to more frequent completions of the initial airway assessment task but fewer completions of ear and lower extremities exams. We did not observe any significant differences in time to task performance, but found increased compliance with the checklist. Although improvements in team performance with the digital checklist were minor, our findings are important because they showed no adverse effects as a result of the digital checklist introduction. We conclude by discussing the takeaways and implications of these results for effective digitization of medical work.
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Affiliation(s)
- Leah Kulp
- College of Computing and Informatics, Drexel University, Philadelphia, PA, USA
| | - Aleksandra Sarcevic
- College of Computing and Informatics, Drexel University, Philadelphia, PA, USA
| | - Megan Cheng
- Trauma and Burn Surgery, Children's National Medical Center, Washington, DC, USA
| | - Yinan Zheng
- Trauma and Burn Surgery, Children's National Medical Center, Washington, DC, USA
| | - Randall S Burd
- Trauma and Burn Surgery, Children's National Medical Center, Washington, DC, USA
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Richardson KM, Fouquet SD, Kerns E, McCulloh RJ. Impact of Mobile Device-Based Clinical Decision Support Tool on Guideline Adherence and Mental Workload. Acad Pediatr 2019; 19:828-834. [PMID: 30853573 PMCID: PMC6732014 DOI: 10.1016/j.acap.2019.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/05/2019] [Accepted: 03/02/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the individual-level impact of an electronic clinical decision support (ECDS) tool, PedsGuide, on febrile infant clinical decision making and cognitive load. METHODS A counterbalanced, prospective, crossover simulation study was performed among attending and trainee physicians. Participants performed simulated febrile infant cases with use of PedsGuide and with standard reference text. Cognitive load was assessed using the NASA-Task Load Index (NASA-TLX), which determines mental, physical, temporal demand, effort, frustration, and performance. Usability was assessed with the System Usability Scale (SUS). Scores on cases and NASA-TLX scores were compared between condition states. RESULTS A total of 32 participants completed the study. Scores on febrile infant cases using PedsGuide were greater compared with standard reference text (89% vs 72%, P = .001). NASA-TLX scores were lower (ie, more optimal) with use of PedsGuide versus control (mental 6.34 vs 11.8, P < .001; physical 2.6 vs 6.1, P = .001; temporal demand 4.6 vs 8.0, P = .003; performance 4.5 vs 8.3, P < .001; effort 5.8 vs 10.7, P < .001; frustration 3.9 vs 10, P < .001). The SUS had an overall score of 88 of 100 with rating of acceptable on the acceptability scale. CONCLUSIONS Use of PedsGuide led to increased adherence to guidelines and decreased cognitive load in febrile infant management when compared with the use of a standard reference tool. This study employs a rarely used method of assessing ECDS tools using a multifaceted approach (medical decision-making, assessing usability, and cognitive workload,) that may be used to assess other ECDS tools in the future.
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Affiliation(s)
| | - Sarah D Fouquet
- Department of Medical Informatics and Telemedicine, Children’s Mercy Kansas City, Kansas City, MO, USA
| | - Ellen Kerns
- Department of Pediatrics, Children’s Hospital & Medical Center, 8200 Dodge Street, Omaha, NE, 68114, USA,Affiliation at the time work was completed: Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, USA
| | - Russell J McCulloh
- Department of Pediatrics, Children’s Hospital & Medical Center, 8200 Dodge Street, Omaha, NE, 68114, USA,Affiliation at the time work was completed: Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, USA
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de Grood C, Job McIntosh C, Boyd JM, Zjadewicz K, Parsons Leigh J, Stelfox HT. Identifying essential elements to include in Intensive Care Unit to hospital ward transfer summaries: A consensus methodology. J Crit Care 2018; 49:27-32. [PMID: 30343010 DOI: 10.1016/j.jcrc.2018.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/17/2018] [Accepted: 10/04/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Transitions of care from the intensive care unit (ICU) to a hospital ward are high risk and contingent on effective communication. We sought to identify essential information elements to be included in an ICU to hospital ward transfer summary tool, and describe tool functionality and composition perceived to be important. MATERIALS AND METHODS A panel of 13 clinicians representing ICU and hospital ward providers used a modified Delphi process to iteratively review and rate unique information elements identified from existing ICU transfer tools through three rounds of review (two remote and one in person). Qualitative content analysis was conducted on transcribed audio recordings of the workshop to characterize tool functionality and composition. RESULTS A total of 141 unique information elements were reviewed of which 63 were identified by panelists as essential. Qualitative content analyses of panelist discussions identified three themes related to how information elements should be considered when developing an ICU transfer summary tool: 1) Flexibility, 2) Usability, and 3) Accountability. CONCLUSION We identified 63 distinct information elements identified as essential for inclusion in an ICU transfer summary tool to facilitate communication between providers during the transition of patient care from the ICU to a hospital ward.
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Affiliation(s)
| | - Chloe de Grood
- Department of Community Health Sciences, TRW Building, 3(rd) Floor, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Christiane Job McIntosh
- Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, 10101 Southport Road SW, Calgary, Alberta T2W 3N2, Canada
| | - Jamie M Boyd
- Department of Community Health Sciences, TRW Building, 3(rd) Floor, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Karolina Zjadewicz
- Alberta Health Services, Ground Floor, McCaig Tower, University of Calgary, 3134 Hospital Drive NW, Calgary, Alberta T2N 2T9, Canada
| | - Jeanna Parsons Leigh
- Department of Community Health Sciences, TRW Building, 3(rd) Floor, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada; Department of Critical Care Medicine, Ground Floor, McCaig Tower, University of Calgary, 3134 Hospital Drive NW, Calgary, Alberta T2N 2T9, Canada
| | - Henry Thomas Stelfox
- Department of Community Health Sciences, TRW Building, 3(rd) Floor, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada; Alberta Health Services, Ground Floor, McCaig Tower, University of Calgary, 3134 Hospital Drive NW, Calgary, Alberta T2N 2T9, Canada; Department of Critical Care Medicine, Ground Floor, McCaig Tower, University of Calgary, 3134 Hospital Drive NW, Calgary, Alberta T2N 2T9, Canada.
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For beginners in anaesthesia, self-training with an audiovisual checklist improves safety during anaesthesia induction. Eur J Anaesthesiol 2018; 35:527-533. [DOI: 10.1097/eja.0000000000000781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Yorkgitis BK, Loughlin JW, Gandee Z, Bates HH, Weinhouse G. Laboratory Tests and X-ray Imaging in a Surgical Intensive Care Unit: Checking the Checklist. J Osteopath Med 2018; 118:305-309. [DOI: 10.7556/jaoa.2018.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Context
Patients in the surgical intensive care unit (ICU) frequently undergo laboratory and imaging testing. These tests can lead to iatrogenic anemia and radiation exposure. Many of these tests may be unnecessary for the management of a patient's illness in the surgical ICU, and their ordering may be a reflex rather than in response to a clinical question. Checklists have been used in critical care to identify and address patient care strategies.
Objective
To examine whether adding a “diagnostic testing” section to a daily checklist used for patient rounds in a surgical ICU would decrease the amount of laboratory tests and chest x-ray imaging ordered.
Methods
An additional section was added to an established ICU daily checklist, which included the following 2 questions: “Is a [chest x-ray] needed for clinical management tomorrow?” and “What laboratory tests are medically necessary for tomorrow?” Comparison was made between 3-month preintervention (control group) and intervention (intervention group) periods. Medical records of hospitalized patients during the preintervention and intervention periods were compared to determine differences in the number of tests ordered per day during each period.
Results
A total of 307 adult patients at a single institution were included in the analysis: 155 in the control group and 152 in the intervention group. The patients in each group were similar in terms of sex, age, Sequential Organ Failure scores, Charlson Comorbidity Index scores, elective admission status, surgical procedures, number of days of mechanical ventilation, ICU length of stay, and in-hospital death. No statistical reductions in laboratory tests or chest x-ray imaging ordered per day from the preintervention to intervention period were found.
Conclusion
The addition of the diagnostic testing section to the daily checklist did not result in a reduction of the amount of tests ordered per day. Further research on test appropriateness and the possible addition of a clinician decision-making tool could be studied in the future to assist with reduction of tests ordered in the surgical ICU.
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Eltaybani S, Mohamed N, Abdelwareth M. Nature of nursing errors and their contributing factors in intensive care units. Nurs Crit Care 2018; 24:47-54. [PMID: 29701274 DOI: 10.1111/nicc.12350] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/03/2018] [Accepted: 02/27/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Errors tend to be multifactorial and so learning from nurses' experiences with them would be a powerful tool toward promoting patient safety. AIM To identify the nature of nursing errors and their contributing factors in intensive care units (ICUs). METHODS A semi-structured interview with 112 critical care nurses to elicit the reports about their encountered errors followed by a content analysis. RESULTS A total of 300 errors were reported. Most of them (94·3%) were classified in more than one error category, e.g. 'lack of intervention', 'lack of attentiveness' and 'documentation errors': these were the most frequently involved error categories. Approximately 40% of reported errors contributed to significant harm or death of the involved patients, with system-related factors being involved in 84·3% of them. More errors occur during the evening shift than the night and morning shifts (42·7% versus 28·7% and 16·7%, respectively). There is a statistically significant relation (p ≤ 0·001) between error disclosure to a nursing supervisor and its impact on the patient. CONCLUSIONS Nurses are more likely to report their errors when they feel safe and when the reporting system is not burdensome, although an internationally standardized language to define and analyse nursing errors is needed. Improving the health care system, particularly the managerial and environmental aspects, might reduce nursing errors in ICUs in terms of their incidence and seriousness. RELEVANCE TO CLINICAL PRACTICE Targeting error-liable times in the ICU, such as mid-evening and mid-night shifts, along with improved supervision and adequate staff reallocation, might tackle the incidence and seriousness of nursing errors. Development of individualized nursing interventions for patients with low health literacy and patients in isolation might create more meaningful dialogue for ICU health care safety.
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Affiliation(s)
- Sameh Eltaybani
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, University of Alexandria, Alexandria, Egypt.,Department of Palliative Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nadia Mohamed
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, University of Alexandria, Alexandria, Egypt
| | - Mona Abdelwareth
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, University of Alexandria, Alexandria, Egypt
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26
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Nan S, Van Gorp P, Lu X, Kaymak U, Korsten H, Vdovjak R, Duan H. A meta-model for computer executable dynamic clinical safety checklists. BMC Med Inform Decis Mak 2017; 17:170. [PMID: 29233155 PMCID: PMC5727863 DOI: 10.1186/s12911-017-0551-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 11/19/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Safety checklist is a type of cognitive tool enforcing short term memory of medical workers with the purpose of reducing medical errors caused by overlook and ignorance. To facilitate the daily use of safety checklists, computerized systems embedded in the clinical workflow and adapted to patient-context are increasingly developed. However, the current hard-coded approach of implementing checklists in these systems increase the cognitive efforts of clinical experts and coding efforts for informaticists. This is due to the lack of a formal representation format that is both understandable by clinical experts and executable by computer programs. METHODS We developed a dynamic checklist meta-model with a three-step approach. Dynamic checklist modeling requirements were extracted by performing a domain analysis. Then, existing modeling approaches and tools were investigated with the purpose of reusing these languages. Finally, the meta-model was developed by eliciting domain concepts and their hierarchies. The feasibility of using the meta-model was validated by two case studies. The meta-model was mapped to specific modeling languages according to the requirements of hospitals. RESULTS Using the proposed meta-model, a comprehensive coronary artery bypass graft peri-operative checklist set and a percutaneous coronary intervention peri-operative checklist set have been developed in a Dutch hospital and a Chinese hospital, respectively. The result shows that it is feasible to use the meta-model to facilitate the modeling and execution of dynamic checklists. CONCLUSIONS We proposed a novel meta-model for the dynamic checklist with the purpose of facilitating creating dynamic checklists. The meta-model is a framework of reusing existing modeling languages and tools to model dynamic checklists. The feasibility of using the meta-model is validated by implementing a use case in the system.
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Affiliation(s)
- Shan Nan
- School of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China.,School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Pieter Van Gorp
- School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Xudong Lu
- School of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China. .,School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Uzay Kaymak
- School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Hendrikus Korsten
- School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Anesthesiology and Intensive Care, Catharina Ziekenhuis in Eindhoven, Eindhoven, The Netherlands
| | | | - Huilong Duan
- School of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China
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27
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Olchanski N, Dziadzko MA, Tiong IC, Daniels CE, Peters SG, O'Horo JC, Gong MN. Can a Novel ICU Data Display Positively Affect Patient Outcomes and Save Lives? J Med Syst 2017; 41:171. [PMID: 28921446 DOI: 10.1007/s10916-017-0810-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Abstract
The aim of this study was to quantify the impact of ProCCESs AWARE, Ambient Clinical Analytics, Rochester, MN, a novel acute care electronic medical record interface, on a range of care process and patient health outcome metrics in intensive care units (ICUs). ProCCESs AWARE is a novel acute care EMR interface that contains built-in tools for error prevention, practice surveillance, decision support and reporting. We compared outcomes before and after AWARE implementation using a prospective cohort and a historical control. The study population included all critically ill adult patients (over 18 years old) admitted to four ICUs at Mayo Clinic, Rochester, MN, who stayed in hospital at least 24 h. The pre-AWARE cohort included 983 patients from 2010, and the post-AWARE cohort included 856 patients from 2014. We analyzed patient health outcomes, care process quality, and hospital charges. After adjusting for patient acuity and baseline demographics, overall in-hospital and ICU mortality odds ratios associated with AWARE intervention were 0.45 (95% confidence interval 0.30 to 0.70) and 0.38 (0.22, 0.66). ICU length of stay decreased by about 50%, hospital length of stay by 37%, and total charges for hospital stay by 30% in post AWARE cohort (by $43,745 after adjusting for patient acuity and demographics). Better organization of information in the ICU with systems like AWARE has the potential to improve important patient outcomes, such as mortality and length of stay, resulting in reductions in costs of care.
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Affiliation(s)
- Natalia Olchanski
- The Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street #63, Boston, MA, 02111, USA.
| | | | - Ing C Tiong
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Craig E Daniels
- Department of Pulmonology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Steve G Peters
- Department of Pulmonology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - John C O'Horo
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
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28
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De Bie A, Nan S, Vermeulen L, Van Gorp P, Bouwman R, Bindels A, Korsten H. Intelligent dynamic clinical checklists improved checklist compliance in the intensive care unit. Br J Anaesth 2017; 119:231-238. [DOI: 10.1093/bja/aex129] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 12/21/2022] Open
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29
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Kulp L, Sarcevic A, Farneth R, Ahmed O, Mai D, Marsic I, Burd RS. Exploring Design Opportunities for a Context-Adaptive Medical Checklist Through Technology Probe Approach. DIS. DESIGNING INTERACTIVE SYSTEMS (CONFERENCE) 2017; 2017:57-68. [PMID: 30381804 DOI: 10.1145/3064663.3064715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This paper explores the workflow and use of an interactive medical checklist for trauma resuscitation-an emerging technology developed for trauma team leaders to support decision making and task coordination among team members. We used a technology probe approach and ethnographic methods, including video review, interviews, and content analysis of checklist logs, to examine how team leaders use the checklist probe during live resuscitations. We found that team leaders of various experience levels use the technology differently. Some leaders frequently glance at the checklist and take notes during task performance, while others place the checklist on a stand and only interact with the checklist when checking items. We compared checklist timestamps to task activities and found that most items are checked off after tasks are performed. We conclude by discussing design implications and new design opportunities for a future dynamic, adaptive checklist.
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Affiliation(s)
- Leah Kulp
- Drexel University, Philadelphia, PA 19104
| | | | | | - Omar Ahmed
- Children's Nat'l Med Center, Washington, DC 20010
| | - Dung Mai
- Drexel University, Philadelphia, PA 19104
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30
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Kogan A, Pennington KM, Vallabhajosyula S, Dziadzko M, Bennett CE, Jensen JB, Gajic O, O'Horo JC. Reliability and Validity of the Checklist for Early Recognition and Treatment of Acute Illness and Injury as a Charting Tool in the Medical Intensive Care Unit. Indian J Crit Care Med 2017; 21:746-750. [PMID: 29279635 PMCID: PMC5699002 DOI: 10.4103/ijccm.ijccm_209_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Resuscitation of critically ill patients is complex and potentially prone to diagnostic errors and therapeutic harm. The Checklist for early recognition and treatment of acute illness and injury (CERTAIN) is an electronic tool that aims to provide decision-support, charting, and prompting for standardization. This study sought to evaluate the validity and reliability of CERTAIN in a real-time Intensive Care Unit (ICU). Materials and Methods: This was a prospective pilot study in the medical ICU of a tertiary care medical center. A total of thirty patient encounters over 2 months period were charted independently by two CERTAIN investigators. The inter-observer recordings and comparison to the electronic medical records (EMR) were used to evaluate reliability and validity, respectively. The primary outcome was reliability and validity measured using Cohen's Kappa statistic. Secondary outcomes included time to completion, user satisfaction, and learning curve. Results: A total of 30 patients with a median age of 59 (42–78) years and median acute physiology and chronic health evaluation III score of 38 (23–50) were included in this study. Inter-observer agreement was very good (κ = 0.79) in this study and agreement between CERTAIN and the EMR was good (κ = 0.5). CERTAIN charting was completed in real-time that was 121 (92–150) min before completion of EMR charting. The subjective learning curve was 3.5 patients without differences in providers with different levels of training. Conclusions: CERTAIN provides a reliable and valid method to evaluate resuscitation events in real time. CERTAIN provided the ability to complete data in real-time.
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Affiliation(s)
- Alexander Kogan
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, MN, USA.,Research Faculty, Multidisciplinary Epidemiology and Translational Research in Intensive Care Laboratory, MN, USA.,Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, MN, USA
| | - Kelly M Pennington
- Research Faculty, Multidisciplinary Epidemiology and Translational Research in Intensive Care Laboratory, MN, USA.,Department of Internal Medicine, Mayo Clinic, MN, USA
| | - Saraschandra Vallabhajosyula
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, MN, USA.,Research Faculty, Multidisciplinary Epidemiology and Translational Research in Intensive Care Laboratory, MN, USA.,Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, MN, USA
| | - Mikhail Dziadzko
- Department of Anesthesiology, Division of Critical Care Anesthesiology, Mayo Clinic, MN, USA
| | - Courtney E Bennett
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, MN, USA.,Research Faculty, Multidisciplinary Epidemiology and Translational Research in Intensive Care Laboratory, MN, USA.,Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, MN, USA
| | - Jeffrey B Jensen
- Department of Anesthesiology, Division of Critical Care Anesthesiology, Mayo Clinic, MN, USA
| | - Ognjen Gajic
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, MN, USA.,Research Faculty, Multidisciplinary Epidemiology and Translational Research in Intensive Care Laboratory, MN, USA
| | - John C O'Horo
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, MN, USA.,Research Faculty, Multidisciplinary Epidemiology and Translational Research in Intensive Care Laboratory, MN, USA.,Department of Internal Medicine, Division of Infectious Diseases, Mayo Clinic, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, MN, USA
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31
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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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32
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Checklist use in ICUs: a French national survey. Intensive Care Med 2015; 41:1149-50. [PMID: 25851393 DOI: 10.1007/s00134-015-3793-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
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