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Muñoz-Bonet JI, Posadas-Blázquez V, González-Galindo L, Sánchez-Zahonero J, Vázquez-Martínez JL, Castillo A, Brines J. Exploring the clinical relevance of vital signs statistical calculations from a new-generation clinical information system. Sci Rep 2023; 13:15068. [PMID: 37699960 PMCID: PMC10497571 DOI: 10.1038/s41598-023-40769-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/16/2023] [Indexed: 09/14/2023] Open
Abstract
New information on the intensive care applications of new generation 'high-density data clinical information systems' (HDDCIS) is increasingly being published in the academic literature. HDDCIS avoid data loss from bedside equipment and some provide vital signs statistical calculations to promote quick and easy evaluation of patient information. Our objective was to study whether manual records of continuously monitored vital signs in the Paediatric Intensive Care Unit could be replaced by these statistical calculations. Here we conducted a prospective observational clinical study in paediatric patients with severe diabetic ketoacidosis, using a Medlinecare® HDDCIS, which collects information from bedside equipment (1 data point per parameter, every 3-5 s) and automatically provides hourly statistical calculations of the central trend and sample dispersion. These calculations were compared with manual hourly nursing records for patient heart and respiratory rates and oxygen saturation. The central tendency calculations showed identical or remarkably similar values and strong correlations with manual nursing records. The sample dispersion calculations differed from the manual references and showed weaker correlations. We concluded that vital signs calculations of central tendency can replace manual records, thereby reducing the bureaucratic burden of staff. The significant sample dispersion calculations variability revealed that automatic random measurements must be supervised by healthcare personnel, making them inefficient.
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Affiliation(s)
- Juan Ignacio Muñoz-Bonet
- Paediatric Intensive Care Unit, Hospital Clínico Universitario, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.
- Department of Paediatrics, Obstetrics, and Gynaecology, University of Valencia, Valencia, Spain.
| | - Vicente Posadas-Blázquez
- Paediatric Intensive Care Unit, Hospital Clínico Universitario, Av. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Laura González-Galindo
- Department of Paediatrics, Obstetrics, and Gynaecology, University of Valencia, Valencia, Spain
| | - Julia Sánchez-Zahonero
- Paediatric Intensive Care Unit, Hospital Clínico Universitario, Av. Blasco Ibáñez 17, 46010, Valencia, Spain
| | | | - Andrés Castillo
- Paediatric Technological Innovation Department, Foundation for Biomedical Research of Hospital Niño Jesús, Madrid, Spain
| | - Juan Brines
- Department of Paediatrics, Obstetrics, and Gynaecology, University of Valencia, Valencia, Spain
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2
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Jones B, Chatfield C. Lessons in quality improvement. BMJ 2022; 376:o475. [PMID: 35210256 DOI: 10.1136/bmj.o475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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3
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Mathieu A, Sauthier M, Jouvet P, Emeriaud G, Brossier D. Validation process of a high-resolution database in a paediatric intensive care unit-Describing the perpetual patient's validation. J Eval Clin Pract 2021; 27:316-324. [PMID: 32372537 DOI: 10.1111/jep.13411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 01/02/2023]
Abstract
RATIONALE High data quality is essential to ensure the validity of clinical and research inferences based on it. However, these data quality assessments are often missing even though these data are used in daily practice and research. AIMS AND OBJECTIVES Our objective was to evaluate the data quality of our high-resolution electronic database (HRDB) implemented in our paediatric intensive care unit (PICU). METHODS We conducted a prospective validation study of a HRDB in a 32-bed paediatric medical, surgical, and cardiac PICU in a tertiary care freestanding maternal-child health centre in Canada. All patients admitted to the PICU with at least one vital sign monitored using a cardiorespiratory monitor connected to the central monitoring station. RESULTS Between June 2017 and August 2018, data from 295 patient days were recorded from medical devices and 4645 data points were video recorded and compared to the corresponding data collected in the HRDB. Statistical analysis showed an excellent overall correlation (R2 = 1), accuracy (100%), agreement (bias = 0, limits of agreement = 0), completeness (2% missing data), and reliability (ICC = 1) between recorded and collected data within clinically significant pre-defined limits of agreement. Divergent points could all be explained. CONCLUSIONS This prospective validation of a representative sample showed an excellent overall data quality.
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Affiliation(s)
- Audrey Mathieu
- Pediatric Intensive Care Unit, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.,CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
| | - Michael Sauthier
- Pediatric Intensive Care Unit, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.,CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
| | - Philippe Jouvet
- Pediatric Intensive Care Unit, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.,CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
| | - Guillaume Emeriaud
- Pediatric Intensive Care Unit, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.,CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
| | - David Brossier
- Pediatric Intensive Care Unit, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.,CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada.,CHU de Caen, Pediatric Intensive Care Unit, Caen, France.,Université Caen Normandie, school of medicine, Caen, France.,Laboratoire de Psychologie Caen Normandie, Université Caen Normandie, Caen, France
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4
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Barasch N, Romig MC, Demko ZO, Dwyer C, Dietz A, Rosen M, Griffiths SM, Ravitz AD, Pronovost PJ, Sapirstein A. Automation and interoperability of a nurse-managed insulin infusion protocol as a model to improve safety and efficiency in the delivery of high-alert medications. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2019. [DOI: 10.1177/2516043519893228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Noah Barasch
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Mark C Romig
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Zoe O Demko
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Cindy Dwyer
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Aaron Dietz
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Michael Rosen
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Steven M Griffiths
- Applied Physics Laboratory, The Johns Hopkins University, Baltimore, MD, USA
| | - Alan D Ravitz
- Applied Physics Laboratory, The Johns Hopkins University, Baltimore, MD, USA
| | - Peter J Pronovost
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Adam Sapirstein
- The Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA
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5
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Mathews SC, Stoll RA, Sternberger WI, Cox PW, Tober TL, Di Mattina J, Dwyer C, Barasch N, Carolan H, Romig M, Pronovost PJ, Barnes JF, Ravitz AD, Sapirstein A. Prioritizing Health Care Solutions for Pressure Ulcers Using the Quality Function Deployment Process. Am J Med Qual 2019; 35:197-204. [PMID: 31446763 DOI: 10.1177/1062860619869990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reducing the incidence and morbidity of pressure ulcers remains a leading national priority in patient safety. However, the optimal strategy for a hospital or health system to address this safety goal is not straightforward given the number and complexity of available solutions. Leveraging techniques from systems engineering, such as the quality function deployment process, may provide a transparent and objective way to address this challenge. A detailed and practical application of quality function deployment is presented that demonstrates the value of applying engineering practices for prioritizing solutions for pressures ulcers specifically and can easily be adapted to other conditions.
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Affiliation(s)
- Simon C Mathews
- Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD
| | - Robert A Stoll
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD
| | | | - Patrick W Cox
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD
| | - Tammy L Tober
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD
| | - Jennifer Di Mattina
- Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD
| | - Cindy Dwyer
- Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD
| | - Noah Barasch
- Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD
| | - Howard Carolan
- Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD
| | - Mark Romig
- Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD
| | | | - John F Barnes
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD
| | - Alan D Ravitz
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD
| | - Adam Sapirstein
- Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD
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Naqvi D, Malik A, Al-Zubaidy M, Naqvi F, Tahir A, Tarfiee A, Vara S, Meyer E. The general practice perspective on barriers to integration between primary and social care: a London, United Kingdom-based qualitative interview study. BMJ Open 2019; 9:e029702. [PMID: 31434776 PMCID: PMC6707672 DOI: 10.1136/bmjopen-2019-029702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE There is an ongoing challenge of effective integration between primary and social care in the United Kingdom; current systems have led to fragmentation of services preventing holistic patient-centred care for vulnerable populations. To improve clinical outcomes and achieve financial efficiencies, the barriers to integration need to be identified and addressed. This study aims to explore the unique perspectives of frontline staff (general practitioners and practice managers) towards these barriers to integration. DESIGN Qualitative study using semistructured interviews and thematic analysis to obtain results. SETTING General practices within London. PARTICIPANTS 18 general practitioners (GPs) and 7 practice managers (PMs) based in London with experience of working with social care. RESULTS The study identified three overarching themes where frontline staff believed problems exist: accessing social services, interprofessional relationships and infrastructure. Issues with contacting staff from other sectors creates delays in referrals for patient care and perpetuates existing logistical challenges. Likewise, professionals noted a hostile working culture between sectors that has resulted in silo working mentalities. In addition to staff being overworked as well as often inefficient multidisciplinary team meetings, poor relationships across sectors cause a diffusion of responsibility, impacting the speed with which patient requests are responded to. Furthermore, participants identified that a lack of interoperability between information systems, lack of pooled budgets and misaligned incentives between managerial staff compound the infrastructural divide between both sectors. CONCLUSION In this study, primary care staff identify intangible barriers to integration such as poor interprofessional relationships, in addition to more well-described structural issues such as insufficient funding and difficulty accessing social care. Participants believe that educating the next generation of medical professionals may lead to the development of collaborative, instead of siloed, working cultures and that change is needed at both an interpersonal and institutional level to successfully integrate care.
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Affiliation(s)
| | | | | | | | | | | | | | - Edgar Meyer
- Imperial College Business School, London, UK
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7
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Griffiths SM, Sapirstein A, Guzman JC, Soriano Z, Ravitz AD. Automated, Web-Based Solution for Bidirectional EHR-Infusion Pump Communication. Biomed Instrum Technol 2019; 53:30-37. [PMID: 30702922 DOI: 10.2345/0899-8205-53.1.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Smart Agent is a web-based solution for establishing bidirectional communication between an infusion pump and an electronic health record (EHR). It eliminates the need for clinician double check of medication administration using an infusion pump. Because the clinician already is using the EHR to review patient health information and update status, the addition of the web service would help eliminate the potential for human error when using a manual system. The Smart Agent process encompasses the reading of pertinent patient data from the EHR, determination of a new medication dosage based on an internal protocol, input of the dosage into an infusion pump, confirmation of the medication dosage acceptance at the infusion pump, and recording the medication change back into the EHR. The widespread use of Smart Agent-type algorithms with bidirectional communication capabilities would result in safer, more efficient provision of care, as well as better value.
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8
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Purao S, Bolloju N, Tan CH. A Modeling Language for Conceptual Design of Systems Integration Solutions. ACM TRANSACTIONS ON MANAGEMENT INFORMATION SYSTEMS 2018. [DOI: 10.1145/3185046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Systems integration—connecting software systems for cross-functional work—is a significant concern in many large organizations, which continue to maintain hundreds, if not thousands, of independently evolving software systems. Current approaches in this space remain ad hoc, and closely tied to technology platforms. Following a design science approach, and via multiple design-evaluate cycles, we develop Systems Integration Requirements Engineering Modeling Language (SIRE-ML) to address this problem. SIRE-ML builds on the foundation of coordination theory, and incorporates important semantic information about the systems integration domain. The article develops constructs in SIRE-ML, and a merge algorithm that allows both functional managers and integration professionals to contribute to building a systems integration solution. Integration models built with SIRE-ML provide benefits such as ensuring coverage and minimizing ambiguity, and can be used to drive implementation with different platforms such as middleware, services, and distributed objects. We evaluate SIRE-ML for ontological expressiveness and report findings about applicability check with an expert panel. The article discusses implications for future research such as tool building and empirical evaluation, as well as implications for practice.
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Abstract
OBJECTIVE Our objective was to construct a prospective high-quality and high-frequency database combining patient therapeutics and clinical variables in real time, automatically fed by the information system and network architecture available through fully electronic charting in our PICU. The purpose of this article is to describe the data acquisition process from bedside to the research electronic database. DESIGN Descriptive report and analysis of a prospective database. SETTING A 24-bed PICU, medical ICU, surgical ICU, and cardiac ICU in a tertiary care free-standing maternal child health center in Canada. PATIENTS All patients less than 18 years old were included at admission to the PICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Between May 21, 2015, and December 31, 2016, 1,386 consecutive PICU stays from 1,194 patients were recorded in the database. Data were prospectively collected from admission to discharge, every 5 seconds from monitors and every 30 seconds from mechanical ventilators and infusion pumps. These data were linked to the patient's electronic medical record. The database total volume was 241 GB. The patients' median age was 2.0 years (interquartile range, 0.0-9.0). Data were available for all mechanically ventilated patients (n = 511; recorded duration, 77,678 hr), and respiratory failure was the most frequent reason for admission (n = 360). The complete pharmacologic profile was synched to database for all PICU stays. Following this implementation, a validation phase is in process and several research projects are ongoing using this high-fidelity database. CONCLUSIONS Using the existing bedside information system and network architecture of our PICU, we implemented an ongoing high-fidelity prospectively collected electronic database, preventing the continuous loss of scientific information. This offers the opportunity to develop research on clinical decision support systems and computational models of cardiorespiratory physiology for example.
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10
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Abstract
Rising pressure from chronic diseases means that we need to learn how to deal with challenges at a different level, including the use of systems approaches that better connect across fragments, such as disciplines, stakeholders, institutions, and technologies. By learning from progress in leading areas of health innovation (including oncology and AIDS), as well as complementary indications (Alzheimer's disease), I try to extract the most enabling innovation paradigms, and discuss their extension to additional areas of application within a systems approach. To facilitate such work, a Precision, P4 or Systems Medicine platform is proposed, which is centered on the representation of health states that enable the definition of time in the vision to provide the right intervention for the right patient at the right time and dose. Modeling of such health states should allow iterative optimization, as longitudinal human data accumulate. This platform is designed to facilitate the discovery of links between opportunities related to a) the modernization of diagnosis, including the increased use of omics profiling, b) patient-centric approaches enabled by technology convergence, including digital health and connected devices, c) increasing understanding of the pathobiological, clinical and health economic aspects of disease progression stages, d) design of new interventions, including therapies as well as preventive measures, including sequential intervention approaches. Probabilistic Markov models of health states, e.g. those used for health economic analysis, are discussed as a simple starting point for the platform. A path towards extension into other indications, data types and uses is discussed, with a focus on regenerative medicine and relevant pathobiology.
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Affiliation(s)
- Michael Rebhan
- Novartis Institutes for Biomedical Research, Basel, 4056, Switzerland
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11
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Affiliation(s)
- Robert L Wears
- Department of Emergency Medicine, University of Florida, Jacksonville, FL, and the Clinical Safety Research Unit, Imperial College London, Paddington, London, UK.
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12
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Automated Charting and Systems Integration: For Patients' Safety and Our Sanity. AACN Adv Crit Care 2016; 26:296-9. [PMID: 26484988 DOI: 10.1097/nci.0000000000000100] [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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13
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Simulation to Improve Patient Safety in Pediatric Emergency Medicine. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Brossier D, Sauthier M, Alacoque X, Masse B, Eltaani R, Guillois B, Jouvet P. Perpetual and Virtual Patients for Cardiorespiratory Physiological Studies. J Pediatr Intensive Care 2016; 5:122-128. [PMID: 31110896 PMCID: PMC6512414 DOI: 10.1055/s-0035-1569998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 10/08/2015] [Indexed: 12/11/2022] Open
Abstract
As a result of innovations in informatics over the last decades, physiologic models elaborated in the second half of the 20th century could be transformed into specific virtual patients called computational models. These models, developed initially for teaching purposes, are of great potential interest in responding to current concerns about improving patient care and safety. However, even if there are obvious advantages to using computational models in cardiorespiratory management, major concerns persist as to their reliability and their ability to recreate real patient physiologic evolution over time. Once developed, these models require complex validation and configuration phases prior to implementation in daily practice. This article focuses on the development of computational models, and reviews the methodologies to clinically validate the models including specific patient databases (perpetual patients) and the use in clinical practice including very high fidelity simulation.
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Affiliation(s)
- David Brossier
- Pediatric Intensive Care Unit, Sainte Justine University Health Centre, Montreal, Quebec, Canada
- Sainte-Justine UHC Research Institute, Sainte Justine University Hospital, Montreal, Canada
| | - Michael Sauthier
- Pediatric Intensive Care Unit, Sainte Justine University Health Centre, Montreal, Quebec, Canada
- Sainte-Justine UHC Research Institute, Sainte Justine University Hospital, Montreal, Canada
| | - Xavier Alacoque
- Department of Anesthesia, Perioperative and Intensive Care, University Hospital of Toulouse, Toulouse, France
- Department of Research, INSERM-Paul Sabattier University, Toulouse, France
| | - Benoit Masse
- Sainte-Justine UHC Research Institute, Sainte Justine University Hospital, Montreal, Canada
| | - Redha Eltaani
- Sainte-Justine UHC Research Institute, Sainte Justine University Hospital, Montreal, Canada
| | - Bernard Guillois
- Department of Neonatology, University Hospital of Caen, Caen, France
| | - Philippe Jouvet
- Pediatric Intensive Care Unit, Sainte Justine University Health Centre, Montreal, Quebec, Canada
- Sainte-Justine UHC Research Institute, Sainte Justine University Hospital, Montreal, Canada
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Abstract
RATIONALE, AIMS AND OBJECTIVES Double checking is a standard practice in many areas of health care, notwithstanding the lack of evidence supporting its efficacy. We ask in this study: 'How do front line practitioners conceptualize double checking? What are the weaknesses of double checking? What alternate views of double checking could render it a more robust process?' METHOD This is part of a larger qualitative study based on 85 semi-structured interviews of health care practitioners in general internal medicine and obstetrics and neonatology; thematic analysis of the transcribed interviews was undertaken. Inductive and deductive themes are reported. RESULTS Weaknesses in the double checking process include inconsistent conceptualization of double checking, double (or more) checking as a costly and time-consuming procedure, double checking trusted as an accepted and stand-alone process, and double checking as preventing reporting of near misses. Alternate views of double checking that would render it a more robust process include recognizing that double checking requires training and a dedicated environment, Introducing automated double checking, and expanding double checking beyond error detection. These results are linked with the concepts of collective efficiency thoroughness trade off (ETTO), an in-family approach, and resilience. CONCLUSION(S) Double checking deserves more questioning, as there are limitations to the process. Practitioners could view double checking through alternate lenses, and thus help strengthen this ubiquitous practice that is rarely challenged.
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Affiliation(s)
- Tanya Hewitt
- Population Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Samia Chreim
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Alan Forster
- Faculty of Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Allen GB, Rounds K, Pronovost PJ. Automated Charting and Systems Integration: For Patients’ Safety and Our Sanity. AACN Adv Crit Care 2015. [DOI: 10.4037/nci.0000000000000100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Gilman B. Allen
- Gilman B. Allen is Director of Adult Critical Care Services and Medical ICU, Division of Pulmonary and Critical Care Medicine, University of Vermont Medical Center, HSRF 220, 149 Beaumont Ave, Burlington, VT 05405
| | - Karen Rounds
- Karen Rounds is Nurse Manager, Medical Intensive Care Unit, University of Vermont Medical Center, Burlington
| | - Peter J. Pronovost
- Peter J. Pronovost is Director of the Armstrong Institute for Patient Safety and Quality; The Johns Hopkins University School of Medicine, Departments of Anesthesiology/Critical Care Medicine and Surgery; The Bloomberg School of Public Health, Department of Health Policy & Management; and The Johns Hopkins University School of Nursing and Carey Business School, Baltimore, Maryland
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17
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Declerck G, Aimé X. Reasons (not) to Spend a Few Billions More on EHRs: How Human Factors Research Can Help. Yearb Med Inform 2014; 9:90-6. [PMID: 25123727 DOI: 10.15265/iy-2014-0033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To select best medical informatics research works published in 2013 on electronic health record (EHR) adoption, design, and impact, from the perspective of human factors and organizational issues (HFOI). METHODS We selected 2,764 papers by querying PubMed (Mesh and TIAB) as well as using a manual search. Papers were evaluated based on pre-defined exclusion and inclusion criteria from their title, keywords, and abstract to select 15 candidate best papers, finally reviewed by 4 external reviewers using a standard evaluation grid. RESULTS Five papers were selected as best papers to illustrate how human factors approaches can improve EHR adoption and design. Among other contributions, these works: (i) make use of the observational and analysis methodologies of social and cognitive sciences to understand clinicians' attitudes towards EHRs, EHR use patterns, and impact on care processes, workflows, information exchange, and coordination of care; (ii) take into account macro- (environmental) and meso- (organizational) level factors to analyze EHR adoption or lack thereof; (iii) highlight the need for qualitative studies to analyze the unexpected side effects of EHRs on cognitive and work processes as well as the persistent use of paper. CONCLUSION Selected papers tend to demonstrate that HFOI approaches and methodologies are essential to bridge the gap between EHR systems and end users, and to reduce regularly reported adoption failures and unexpected consequences.
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Miranda ML, Ferranti J, Strauss B, Neelon B, Califf RM. Geographic health information systems: a platform to support the 'triple aim'. Health Aff (Millwood) 2014; 32:1608-15. [PMID: 24019366 DOI: 10.1377/hlthaff.2012.1199] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Despite the rapid growth of electronic health data, most data systems do not connect individual patient records to data sets from outside the health care delivery system. These isolated data systems cannot support efforts to recognize or address how the physical and environmental context of each patient influences health choices and health outcomes. In this article we describe how a geographic health information system in Durham, North Carolina, links health system and social and environmental data via shared geography to provide a multidimensional understanding of individual and community health status and vulnerabilities. Geographic health information systems can be useful in supporting the Institute for Healthcare Improvement's Triple Aim Initiative to improve the experience of care, improve the health of populations, and reduce per capita costs of health care. A geographic health information system can also provide a comprehensive information base for community health assessment and intervention for accountable care that includes the entire population of a geographic area.
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19
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Pageler NM, Longhurst CA, Wood M, Cornfield DN, Suermondt J, Sharek PJ, Franzon D. Use of electronic medical record-enhanced checklist and electronic dashboard to decrease CLABSIs. Pediatrics 2014; 133:e738-46. [PMID: 24567021 PMCID: PMC3934335 DOI: 10.1542/peds.2013-2249] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We hypothesized that a checklist enhanced by the electronic medical record and a unit-wide dashboard would improve compliance with an evidence-based, pediatric-specific catheter care bundle and decrease central line-associated bloodstream infections (CLABSI). METHODS We performed a cohort study with historical controls that included all patients with a central venous catheter in a 24-bed PICU in an academic children's hospital. Postintervention CLABSI rates, compliance with bundle elements, and staff perceptions of communication were evaluated and compared with preintervention data. RESULTS CLABSI rates decreased from 2.6 CLABSIs per 1000 line-days before intervention to 0.7 CLABSIs per 1000 line-days after intervention. Analysis of specific bundle elements demonstrated increased daily documentation of line necessity from 30% to 73% (P < .001), increased compliance with dressing changes from 87% to 90% (P = .003), increased compliance with cap changes from 87% to 93% (P < .001), increased compliance with port needle changes from 69% to 95% (P < .001), but decreased compliance with insertion bundle documentation from 67% to 62% (P = .001). Changes in the care plan were made during review of the electronic medical record checklist on 39% of patient rounds episodes. CONCLUSIONS Use of an electronic medical record-enhanced CLABSI prevention checklist coupled with a unit-wide real-time display of adherence was associated with increased compliance with evidence-based catheter care and sustained decrease in CLABSI rates. These data underscore the potential for computerized interventions to promote compliance with proven best practices and prevent patient harm.
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Affiliation(s)
- Natalie M. Pageler
- Center for Excellence in Pulmonary Biology, Divisions of Pulmonary, Asthma and Critical Care Medicine,,Department of Clinical Informatics, and
| | - Christopher A. Longhurst
- Division of Systems Medicine, and,Division of General Pediatrics, Department of Pediatrics, Stanford University Medical School, Stanford, California;,Department of Clinical Informatics, and
| | - Matthew Wood
- Center for Quality and Clinical Effectiveness, Lucile Packard Children’s Hospital at Stanford, Stanford, California; and
| | - David N. Cornfield
- Center for Excellence in Pulmonary Biology, Divisions of Pulmonary, Asthma and Critical Care Medicine
| | | | - Paul J. Sharek
- Division of General Pediatrics, Department of Pediatrics, Stanford University Medical School, Stanford, California;,Center for Quality and Clinical Effectiveness, Lucile Packard Children’s Hospital at Stanford, Stanford, California; and
| | - Deborah Franzon
- Center for Excellence in Pulmonary Biology, Divisions of Pulmonary, Asthma and Critical Care Medicine
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Militello LG, Arbuckle NB, Saleem JJ, Patterson E, Flanagan M, Haggstrom D, Doebbeling BN. Sources of variation in primary care clinical workflow: implications for the design of cognitive support. Health Informatics J 2013; 20:35-49. [PMID: 24105625 DOI: 10.1177/1460458213476968] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article identifies sources of variation in clinical workflow and implications for the design and implementation of electronic clinical decision support. Sources of variation in workflow were identified via rapid ethnographic observation, focus groups, and interviews across a total of eight medical centers in both the Veterans Health Administration and academic medical centers nationally regarded as leaders in developing and using clinical decision support. Data were reviewed for types of variability within the social and technical subsystems and the external environment as described in the sociotechnical systems theory. Two researchers independently identified examples of variation and their sources, and then met with each other to discuss them until consensus was reached. Sources of variation were categorized as environmental (clinic staffing and clinic pace), social (perception of health information technology and real-time use with patients), or technical (computer access and information access). Examples of sources of variation within each of the categories are described and discussed in terms of impact on clinical workflow. As technologies are implemented, barriers to use become visible over time as users struggle to adapt workflow and work practices to accommodate new technologies. Each source of variability identified has implications for the effective design and implementation of useful health information technology. Accommodating moderate variability in workflow is anticipated to avoid brittle and inflexible workflow designs, while also avoiding unnecessary complexity for implementers and users.
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Tropello SP, Ravitz AD, Romig M, Pronovost PJ, Sapirstein A. Enhancing the Quality of Care in the Intensive Care Unit. Crit Care Clin 2013. [DOI: 10.1016/j.ccc.2012.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Disorganized care: the findings of an iterative, in-depth analysis of surgical morbidity and mortality. J Surg Res 2012; 177:43-8. [DOI: 10.1016/j.jss.2012.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 04/26/2012] [Accepted: 05/02/2012] [Indexed: 01/24/2023]
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Jouvet P, Eddington A, Payen V, Bordessoule A, Emeriaud G, Gasco RL, Wysocki M. A pilot prospective study on closed loop controlled ventilation and oxygenation in ventilated children during the weaning phase. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R85. [PMID: 22591622 PMCID: PMC3580628 DOI: 10.1186/cc11343] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 05/16/2012] [Indexed: 12/27/2022]
Abstract
Introduction The present study is a pilot prospective safety evaluation of a new closed loop computerised protocol on ventilation and oxygenation in stable, spontaneously breathing children weighing more than 7 kg, during the weaning phase of mechanical ventilation. Methods Mechanically ventilated children ready to start the weaning process were ventilated for five periods of 60 minutes in the following order: pressure support ventilation, adaptive support ventilation (ASV), ASV plus a ventilation controller (ASV-CO2), ASV-CO2 plus an oxygenation controller (ASV-CO2-O2) and pressure support ventilation again. Based on breath-by-breath analysis, the percentage of time with normal ventilation as defined by a respiratory rate between 10 and 40 breaths/minute, tidal volume > 5 ml/kg predicted body weight and end-tidal CO2 between 25 and 55 mmHg was determined. The number of manipulations and changes on the ventilator were also recorded. Results Fifteen children, median aged 45 months, were investigated. No adverse event and no premature protocol termination were reported. ASV-CO2 and ASV-CO2-O2 kept the patients within normal ventilation for, respectively, 94% (91 to 96%) and 94% (87 to 96%) of the time. The tidal volume, respiratory rate, peak inspiratory airway pressure and minute ventilation were equivalent for all modalities, although there were more automatic setting changes in ASV-CO2 and ASV-CO2-O2. Positive end-expiratory pressure modifications by ASV-CO2-O2 require further investigation. Conclusion Over the short study period and in this specific population, ASV-CO2 and ASV-CO2-O2 were safe and kept the patient under normal ventilation most of the time. Further research is needed, especially for positive end-expiratory pressure modifications by ASV-CO2-O2. Trial registration ClinicalTrials.gov: NCT01095406
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Rosen MA, Hunt EA, Pronovost PJ, Federowicz MA, Weaver SJ. In situ simulation in continuing education for the health care professions: a systematic review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2012; 32:243-54. [PMID: 23280527 DOI: 10.1002/chp.21152] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Education in the health sciences increasingly relies on simulation-based training strategies to provide safe, structured, engaging, and effective practice opportunities. While this frequently occurs within a simulation center, in situ simulations occur within an actual clinical environment. This blending of learning and work environments may provide a powerful method for continuing education. However, as this is a relatively new strategy, best practices for the design and delivery of in situ learning experiences have yet to be established. This article provides a systematic review of the in situ simulation literature and compares the state of the science and practice against principles of effective education and training design, delivery, and evaluation. METHODS A total of 3190 articles were identified using academic databases and screened for descriptive accounts or studies of in situ simulation programs. Of these, 29 full articles were retrieved and coded using a standard data extraction protocol (kappa = 0.90). RESULTS In situ simulations have been applied to foster individual, team, unit, and organizational learning across several clinical and nonclinical areas. Approaches to design, delivery, and evaluation of the simulations were highly variable across studies. The overall quality of in situ simulation studies is low. A positive impact of in situ simulation on learning and organizational performance has been demonstrated in a small number of studies. DISCUSSION The evidence surrounding in situ simulation efficacy is still emerging, but the existing research is promising. Practical program planning strategies are evolving to meet the complexity of a novel learning activity that engages providers in their actual work environment.
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Affiliation(s)
- Michael A Rosen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
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Goldsmith D, Siegel M. Improving Health Care Management Through the Use of Dynamic Simulation Modeling and Health Information Systems. INTERNATIONAL JOURNAL OF INFORMATION TECHNOLOGIES AND SYSTEMS APPROACH 2012. [DOI: 10.4018/jitsa.2012010102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To better understand the performance of hospital operations in response to IT-enabled improvement, this paper reports the results of a system dynamics model designed to improve core medical processes. Utilizing system dynamics modeling and emerging Health Information Systems (HIS) data, the authors demonstrate how current behavior within the hospital leads to a ‘stove-pipe’ effect, in which each functional group employs policies that are rational at the group level, but that lead to inefficiencies at the hospital level. The authors recommend management improvements in both materials and staff utilization to address the stove-pipe effect, estimate the resultant cost-saving, and report the results of an experiment conducted in the hospital to validate the approach. Results indicate that the major gains in health information systems use will accompany new information gathering capabilities, as these capabilities result in collections of data that can be used to greatly improve patient safety, hospital operations, and medical decision support.
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