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Marx G, Bickenbach J, Fritsch SJ, Kunze JB, Maassen O, Deffge S, Kistermann J, Haferkamp S, Lutz I, Voellm NK, Lowitsch V, Polzin R, Sharafutdinov K, Mayer H, Kuepfer L, Burghaus R, Schmitt W, Lippert J, Riedel M, Barakat C, Stollenwerk A, Fonck S, Putensen C, Zenker S, Erdfelder F, Grigutsch D, Kram R, Beyer S, Kampe K, Gewehr JE, Salman F, Juers P, Kluge S, Tiller D, Wisotzki E, Gross S, Homeister L, Bloos F, Scherag A, Ammon D, Mueller S, Palm J, Simon P, Jahn N, Loeffler M, Wendt T, Schuerholz T, Groeber P, Schuppert A. Algorithmic surveillance of ICU patients with acute respiratory distress syndrome (ASIC): protocol for a multicentre stepped-wedge cluster randomised quality improvement strategy. BMJ Open 2021; 11:e045589. [PMID: 34550901 PMCID: PMC8039261 DOI: 10.1136/bmjopen-2020-045589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The acute respiratory distress syndrome (ARDS) is a highly relevant entity in critical care with mortality rates of 40%. Despite extensive scientific efforts, outcome-relevant therapeutic measures are still insufficiently practised at the bedside. Thus, there is a clear need to adhere to early diagnosis and sufficient therapy in ARDS, assuring lower mortality and multiple organ failure. METHODS AND ANALYSIS In this quality improvement strategy (QIS), a decision support system as a mobile application (ASIC app), which uses available clinical real-time data, is implemented to support physicians in timely diagnosis and improvement of adherence to established guidelines in the treatment of ARDS. ASIC is conducted on 31 intensive care units (ICUs) at 8 German university hospitals. It is designed as a multicentre stepped-wedge cluster randomised QIS. ICUs are combined into 12 clusters which are randomised in 12 steps. After preparation (18 months) and a control phase of 8 months for all clusters, the first cluster enters a roll-in phase (3 months) that is followed by the actual QIS phase. The remaining clusters follow in month wise steps. The coprimary key performance indicators (KPIs) consist of the ARDS diagnostic rate and guideline adherence regarding lung-protective ventilation. Secondary KPIs include the prevalence of organ dysfunction within 28 days after diagnosis or ICU discharge, the treatment duration on ICU and the hospital mortality. Furthermore, the user acceptance and usability of new technologies in medicine are examined. To show improvements in healthcare of patients with ARDS, differences in primary and secondary KPIs between control phase and QIS will be tested. ETHICS AND DISSEMINATION Ethical approval was obtained from the independent Ethics Committee (EC) at the RWTH Aachen Faculty of Medicine (local EC reference number: EK 102/19) and the respective data protection officer in March 2019. The results of the ASIC QIS will be presented at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER DRKS00014330.
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Affiliation(s)
- Gernot Marx
- Department of Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Johannes Bickenbach
- Department of Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Sebastian Johannes Fritsch
- Department of Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Juelich Supercomputing Centre, Forschungszentrum Juelich GmbH, Juelich, Germany
| | - Julian Benedict Kunze
- Department of Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Oliver Maassen
- Department of Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Saskia Deffge
- Department of Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Jennifer Kistermann
- Department of Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Silke Haferkamp
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Division Information Technology, University Hospital Aachen, Aachen, Germany
| | - Irina Lutz
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Division Information Technology, University Hospital Aachen, Aachen, Germany
| | - Nora Kristiana Voellm
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Division Information Technology, University Hospital Aachen, Aachen, Germany
| | - Volker Lowitsch
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Healthcare IT Solutions GmbH, Aachen, Germany
| | - Richard Polzin
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Institute for Computational Biomedicine II, RWTH Aachen University, Aachen, Germany
| | - Konstantin Sharafutdinov
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Institute for Computational Biomedicine II, RWTH Aachen University, Aachen, Germany
| | - Hannah Mayer
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Systems Pharmacology & Medicine, Bayer AG, Leverkusen, Germany
| | - Lars Kuepfer
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Systems Pharmacology & Medicine, Bayer AG, Leverkusen, Germany
| | - Rolf Burghaus
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Systems Pharmacology & Medicine, Bayer AG, Leverkusen, Germany
| | - Walter Schmitt
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Clinical Pharmacometry, Bayer AG, Leverkusen, Germany
| | - Joerg Lippert
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Clinical Pharmacometry, Bayer AG, Leverkusen, Germany
| | - Morris Riedel
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Juelich Supercomputing Centre, Forschungszentrum Juelich GmbH, Juelich, Germany
| | - Chadi Barakat
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Juelich Supercomputing Centre, Forschungszentrum Juelich GmbH, Juelich, Germany
| | - André Stollenwerk
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Informatik 11 - Embedded Software, RWTH Aachen University, Aachen, Germany
| | - Simon Fonck
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Informatik 11 - Embedded Software, RWTH Aachen University, Aachen, Germany
| | - Christian Putensen
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Bonn, Bonn, Germany
| | - Sven Zenker
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Bonn, Bonn, Germany
- Staff Unit for Medical and Scientific Technology Development and Coordination, Commercial Directorate, University of Bonn Medical Center, Applied Medical Informatics, Institute for Biometrics, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Felix Erdfelder
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Bonn, Bonn, Germany
- Staff Unit for Medical and Scientific Technology Development and Coordination, Commercial Directorate, University of Bonn Medical Center, Applied Medical Informatics, Institute for Biometrics, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Daniel Grigutsch
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Bonn, Bonn, Germany
- Staff Unit for Medical and Scientific Technology Development and Coordination, Commercial Directorate, University of Bonn Medical Center, Applied Medical Informatics, Institute for Biometrics, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Rainer Kram
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Susanne Beyer
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- IT Department, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Knut Kampe
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Erik Gewehr
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Research IT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friederike Salman
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick Juers
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Research IT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Tiller
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- IT Department, Data Integration Center, University Hospital Halle, Halle, Germany
| | - Emilia Wisotzki
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- IT Department, Data Integration Center, University Hospital Halle, Halle, Germany
| | - Sebastian Gross
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Halle, Germany
| | - Lorenz Homeister
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Halle, Germany
| | - Frank Bloos
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - André Scherag
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Danny Ammon
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- IT Department, Data Integration Center, Jena University Hospital, Jena, Germany
| | - Susanne Mueller
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Julia Palm
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Philipp Simon
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Nora Jahn
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Markus Loeffler
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | - Thomas Wendt
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Data Integration Center, IT Department, University Hospital Leipzig, Leipzig, Germany
| | - Tobias Schuerholz
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
| | - Petra Groeber
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- IT Department, Rostock University Medical Center, Rostock, Germany
| | - Andreas Schuppert
- SMITH consortium of the German Medical Informatics Initiative, Leipzig, Germany
- Institute for Computational Biomedicine II, RWTH Aachen University, Aachen, Germany
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