ABSTRACT
BACKGROUND: The effectiveness of practice bundles on reducing ventilator-associated pneumonia (VAP) has been questioned. OBJECTIVE: To implement a comprehensive program that included a real-time bundle compliance dashboard to improve compliance and reduce ventilator-associated complications. DESIGN Before-and-after quasi-experimental study with interrupted time-series analysis. SETTING Academic medical center. METHODS: In 2007 a comprehensive institutional ventilator bundle program was developed. To assess bundle compliance and stimulate instant course correction of noncompliant parameters, a real-time computerized dashboard was developed. Program impact in 6 adult intensive care units (ICUs) was assessed. Bundle compliance was noted as an overall cumulative bundle adherence assessment, reflecting the percentage of time all elements were concurrently in compliance for all patients. RESULTS: The VAP rate in all ICUs combined decreased from 19.5 to 9.2 VAPs per 1,000 ventilator-days following program implementation (P<.001). Bundle compliance significantly increased (Z100 score of 23% in August 2007 to 83% in June 2011 [P<.001]). The implementation resulted in a significant monthly decrease in the overall ICU VAP rate of 3.28/1,000 ventilator-days (95% CI, 2.64-3.92/1,000 ventilator-days). Following the intervention, the VAP rate decreased significantly at a rate of 0.20/1,000 ventilator-days per month (95% CI, 0.14-0.30/1,000 ventilator-days per month). Among all adult ICUs combined, improved bundle compliance was moderately correlated with monthly VAP rate reductions (Pearson correlation coefficient, -0.32). CONCLUSION: A prevention program using a real-time bundle adherence dashboard was associated with significant sustained decreases in VAP rates and an increase in bundle compliance among adult ICU patients.
Subject(s)
Cross Infection/prevention & control , Guideline Adherence , Infection Control/methods , Intensive Care Units/standards , Pneumonia, Ventilator-Associated/prevention & control , Respiration, Artificial/adverse effects , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Interrupted Time Series Analysis , Male , Middle Aged , Young AdultABSTRACT
OBJECTIVE: Clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety; however, effective implementation of CDS requires effective clinical and technical governance structures. The authors sought to determine the range and variety of these governance structures and identify a set of recommended practices through observational study. DESIGN: Three site visits were conducted at institutions across the USA to learn about CDS capabilities and processes from clinical, technical, and organizational perspectives. Based on the results of these visits, written questionnaires were sent to the three institutions visited and two additional sites. Together, these five organizations encompass a variety of academic and community hospitals as well as small and large ambulatory practices. These organizations use both commercially available and internally developed clinical information systems. MEASUREMENTS: Characteristics of clinical information systems and CDS systems used at each site as well as governance structures and content management approaches were identified through extensive field interviews and follow-up surveys. RESULTS: Six recommended practices were identified in the area of governance, and four were identified in the area of content management. Key similarities and differences between the organizations studied were also highlighted. CONCLUSION: Each of the five sites studied contributed to the recommended practices presented in this paper for CDS governance. Since these strategies appear to be useful at a diverse range of institutions, they should be considered by any future implementers of decision support.
Subject(s)
Decision Support Systems, Clinical/organization & administration , Quality Assurance, Health Care/organization & administration , Health Plan Implementation , Humans , Organizational Case Studies , United StatesABSTRACT
Studies have shown that ventilator weaning protocols have resulted in a reduction in duration of mechanical ventilation, ventilator-associated pneumonia, and the rate of re-intubation when compared to weaning directed by a physician. This project continuously monitors weaning status and provides feedback on each patients status. The specific aim of this project is to improve the adherence to ventilator management and ventilator weaning protocols.
Subject(s)
Guideline Adherence/organization & administration , Medical Records Systems, Computerized/organization & administration , Medical Records Systems, Computerized/standards , Outcome Assessment, Health Care/methods , Practice Guidelines as Topic , Ventilator Weaning/methods , Ventilator Weaning/standards , Humans , Treatment Outcome , United StatesABSTRACT
Technology can be used effectively to improve chronic disease management, impacting health care costs, safety, and quality. The Agency for Healthcare Research and Quality has funded several studies to examine best practices in using technology to impact chronic disease management. These projects have employed a variety of technologies to improve care delivery processes, patient education, and continuity of care. Their stories contain valuable lessons for others looking to enhance chronic disease care.
Subject(s)
Chronic Disease/therapy , Medical Informatics Applications , Benchmarking , Disease Management , Humans , United States , United States Agency for Healthcare Research and QualityABSTRACT
Fully mapping laboratory tests to LOINC greatly increases functionality within a regional data exchange, but it is a costly process. As an inexpensive approach, we defined 53 "clinically significant" labs to map within the Memphis, Tennessee RHIO. These tests comprised a small percentage of unique test codes but a large percentage of laboratory message volume. We propose mapping a few clinically significant laboratory tests can deliver a low cost increase in functionality for a RHIO.
Subject(s)
Clinical Laboratory Techniques/classification , Logical Observation Identifiers Names and Codes , Clinical Laboratory Information Systems , Medical Records Systems, Computerized , Regional Medical Programs , Tennessee , Vocabulary, ControlledABSTRACT
Many institutions find it difficult to achieve compliance with quality measures associated with community acquired pneumonia. The goal of this study was to design and implement an automated pneumonia detection and management system in the Emergency Department. The system utilizes multiple information systems to improve communication among health care providers and support more timely decision making for ED patients suggestive of having pneumonia.
Subject(s)
Decision Making, Computer-Assisted , Pneumonia/therapy , Adult , Algorithms , Community-Acquired Infections/diagnosis , Community-Acquired Infections/therapy , Emergency Service, Hospital , Humans , Medical Records Systems, Computerized , Pneumonia/diagnosis , Quality of Health CareABSTRACT
Order sets have been used to make evidence-based guidelines actionable at the point of care with evidence of improved outcomes. In order to understand the impact evidence-based order sets might have on patients and providers at Vanderbilt, it is important to understand current and past use of order sets. This study examined ordering patterns over a 6-year period and results are reported.
