improving accessibility of key information during ... · lor # = level of reliability number, e.g.,...
TRANSCRIPT
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Improving Accessibility of Key
Information During Resuscitations:
Implementation of a Large Screen
Electronic Dashboard
Andrea Rinderknecht, Kim Parker, Mary Frey, Michael
Fitzgerald, Bruce Dellaposta, Jennifer Oehler
Division of Emergency Medicine
Cincinnati Children’s Hospital Medical Center
University of Cincinnati School of Medicine
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Disclosures
The authors have no financial relationships to
disclose or conflicts of interest to resolve.
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Background:ED Resuscitations
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Background
Team leading during resuscitations
• High cognitive load
• Situational awareness
• Communication
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Current System
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Improve access to key data during resuscitation
Project Goal
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Requirements of Solution
• Leverage existing technology
• Display key data from multiple sources
• Easily visible / digestible format
• Require minimal (or no) user interaction
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Test System
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Capabilities – Front Screen
Front Screen Capabilities
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Front Screen –
Video Laryngoscope Output
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Rear Screen Capabilities
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Study Objective
Assess provider perception of accessibility of key
data prior to and after implementation of the large
screen electronic dashboard
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Methods
• Setting
– Resuscitation suite
– High volume ED
– Large, tertiary care children’s hospital
• Patients
– Critically ill
– Medical and Traumatic etiologies
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Methods
• Custom-designed survey (Qualtrics)
– Respondents
• MD team leaders
• RN team leaders
– Primary outcome
• Perceived accessibility of key data during
resuscitations
– Secondary outcomes
• Perceived importance of key data during resuscitations
• Reason for perceived importance
• Statistical Analysis
– Paired samples t-tests to compare mean differences
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Primary Outcome
Accessibility of Data Elements
Vital Signs
• Current
• Previous
• Trend
Lab results
• Point of care
• Sent to Lab
Duration of Resuscitation
• Time since start
Radiographic studies
• Image available
• Reading available
Medications
• Name
• Dose administered
• Time since dose
administered
Procedures
• Procedures performed
• Time since procedure
performed
• View of ETT passing vocal
cords during Intubation
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• Test Period: Jan 12 – Mar 16, 2015
• Completion of survey
– 21/45 (47%) eligible MDs
– 12/25 (48%) eligible RNs
Inclusion
Criteria
Patients
Seen in
Test
Bay
Length of
Stay
(Range in
Min)
MD Providers
(including 3rd
year fellows)
RN Team Leader
Providers
Medical,
Trauma Alerts
and
Trauma Stats
271 8 - 185 40 38
Results
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Secondary Outcomes
• Perceived importance of data elements
– Mean scores > 4 for all
• Except time elapsed since the start of the resuscitation
– Scale: 1-6
• 4 = Important
• 5 = Very Important
• 6 = Essential
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• Impact of data accessibility
– Timeliness of decisions
– Situational awareness
– Ability to assess patient
• “KEEP IT” – 100% of respondents
– NO changes – 35%
– MINOR changes – 63%
– MAJOR changes – 2%
Secondary Outcomes
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Limitations
• Method
– Survey: not validated
• Improvement noted in data not expected to improve
– Current Vital Signs
– Number of doses of medication given
– Overall improved situational awareness and decreased cognitive load?
• Outcomes chosen
– Provider satisfaction
– Did not measure outcome on patient
• Very difficult to study
– Heterogeneity and rarity of presentations
– Selection of measures / outcomes
– Time / Resource Intensive
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Conclusion
The development and implementation of a large
screen electronic dashboard significantly
improved physician and nursing team leaders’
perception of accessibility of key data
required during resuscitative care.
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Next Steps
• Improving our solution
• Install in remaining resuscitation bays?
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Acknowledgements
• Kim Parker
• Mary Frey, MSN, RN, CNL, CPN, CPEN
• Michael Fitzgerald, PhD
• Bruce Dellaposta, Ed.D., LSSMBB
• Jennifer Oehler, MSN, RN
• Margot Daugherty, RN
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Questions
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Projected cost per Bay
• < $20,000 – 2 large screen LEDs
– 2 processor systems
– Cable, HDMI plate, other equipment
– Mouse and pad controller
– Construction costs
• Priceless– CCHMC EPIC analyst time and effort to customize
and interact with EPIC to perfect / improve system
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Our Team
• Multidisciplinary input
– PEM physician
– Experienced RN team leader
– EPIC analyst
– Trauma services RN
– Quality improvement experts
– Parent Advisory Committee
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Perceived importance of Key Data
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Reasons for Perceived importance
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Background – Our Story
• Setting - CCHMC Emergency Department (ED)
– Total Volume (annual) ~100,000 patient encounters
– April 1, 2014 – March 31, 2015
• ED – 62,991
• Resuscitation Suite – 3,753 (6%)
– Medical – 2095 (56%)
– Trauma Alert or Stat – 402 (11%)
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Resuscitation Team Make-up
• MDs – PEM Team Leaders (45)
– Bedside MDs (Residents – Pediatric, EM, Family)
– Trauma Surgery (Resident, Fellow, Attending)
• RNs – Trauma Core RN Team leaders (38)
– Bedside, Medication RNs
• Additional (integrated and ad hoc)– Paramedics
– Patient Care Attendants
– OR Staff
– Anesthesia
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SMART Aim
Key Drivers Interventions (LOR #)
Increase the % of
survey respondents
who selected easy on
the accessibility to
key data in STS from
X to Y using a pre and
post-survey by 5/1/15
Population: ED MD and
RN team leaders
Accumulation of data over
time
Accumulation of data from
multiple sources
Appropriate utilization and
maximization of technology
Appropriate team make-up
Create a communication board as a
patient log (LOR 1)
Integrate STS dashboard (LOR 2)Clear communication
Key
Gray shaded box = completed intervention
Green shaded box = what we’re working on right now
LOR # = Level of Reliability Number, e.g., LOR 1
Improving the Availability of Data Key Driver Diagram (KDD)
Project Leader(s): Andrea Rinderknecht, MD
Mary Frey, RN Revision Date: 3/19/2015
Improve safety, quality,
and reliability of care
for STS patients
Global Aim
Add staff resources to gather and
communicate data (LOR 1)
Remove barriers to data entry/display
(LOR 1)
Implement a BPA/reminder to review
vitals every 5 minutes (LOR 2)
Improve team leader cognitive
capacity (LOR 1)
Limitations of current
technology
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Resuscitation Suite Documentation
• Electronic Medical Record
– November 2012
• Improved documentation (more detailed)
• Negative effect on RN team leader’s capacity to co-team
lead