Domain

Learning Health System

Type

Case Study or Comparative Case Study

Theme

effectiveness; quality

Start Date

7-6-2014 1:15 PM

End Date

7-6-2014 2:45 PM

Structured Abstract

Introduction

Electronic health record (EHR) tools that enhance clinical workflow and provide real-time performance feedback can improve adoption of patient safety practices. Delirium is a common and severe problem for intensive care unit (ICU) patients that may be prevented or mitigated through the use of evidence-based care processes such as those included in the ABCDE bundle. We describe our approach for using electronic health record (EHR) tools and data to facilitate the implementation of the ABCDE bundle in the ICUs of three hospitals and evaluate the effect of the bundle on adherence to delirium care processes and patient outcomes.

Background/Methods

The ABCDE bundle consists of 5 elements including awakening trials to decrease the use of sedation, breathing trials to wean patients off mechanical ventilation faster, coordination of awakening and breathing trials to maximize their benefits, delirium screening/management, and early progressive mobility to prevent muscle weakness. In order to facilitate uptake of ABCDE practices and measure adoption of those care processes during and following bundle implementation, we embedded a critical care flowsheet in the EHR that incorporates ABCDE processes into the clinical workflow and allows for expedited capture of the performance of ABCDE care processes, sedation levels, and incidence of delirium. Recognizing that real-time information is needed to identify gaps in patient care and improve bundle adoption, we have also leveraged the EHR to develop a dashboarding tool that allows ICU managers to pull data regarding bundle compliance from the critical care flowsheet, monitor key performance indicators, and provide feedback to frontline staff.

Innovation

The creation of the critical care flowsheet and the associated performance reporting tool allows for measurement and concurrent intervention (“measure-vention”) to address gaps in the delivery of evidenced-based care processes for delirium prevention/mitigation and accelerate bundle adherence. Currently, most quality and safety data are still derived from retrospective and labor-intensive sampling of patient populations via manual chart review and shared months after the care processes of interest have been performed. The measure-vention tactics deployed in this project allow for use of EHR data to improve patient care at the point of maximal benefit-while they are still in the hospital.

Discussion

Valuable data regarding delivery of care and patient outcomes are often contained within EHRs but are difficult to abstract in a timely and efficient manner. By creating a critical care flowsheet in the EHR to facilitate delivery of a care bundle for delirium prevention and collect data regarding bundle adherence and creating a reporting tool that enables real-time performance feedback, we are building a learning health system and a generalizable framework for the identification of current gaps in care and the simultaneous collection of data that will be useful for comparative effectiveness and patient-centered outcomes research.

Next Steps

Following implementation of the performance reporting tool, we will abstract patient outcomes data from the EHR to determine bundle adherence rates and the effect of bundle implementation on patient outcomes including incidence and duration of delirium, ventilator days, coma days, length of stay, nursing home utilization, and mortality.

Acknowledgements

This work was supported by a grant from the Agency for Healthcare Research & Quality (Grant Number: 1R18HS021459)

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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Jun 7th, 1:15 PM Jun 7th, 2:45 PM

Use of Electronic Health Record Tools and Data to Facilitate the Implementation and Evaluation of a Bundled Care Process for Delirium in the Intensive Care Unit

Introduction

Electronic health record (EHR) tools that enhance clinical workflow and provide real-time performance feedback can improve adoption of patient safety practices. Delirium is a common and severe problem for intensive care unit (ICU) patients that may be prevented or mitigated through the use of evidence-based care processes such as those included in the ABCDE bundle. We describe our approach for using electronic health record (EHR) tools and data to facilitate the implementation of the ABCDE bundle in the ICUs of three hospitals and evaluate the effect of the bundle on adherence to delirium care processes and patient outcomes.

Background/Methods

The ABCDE bundle consists of 5 elements including awakening trials to decrease the use of sedation, breathing trials to wean patients off mechanical ventilation faster, coordination of awakening and breathing trials to maximize their benefits, delirium screening/management, and early progressive mobility to prevent muscle weakness. In order to facilitate uptake of ABCDE practices and measure adoption of those care processes during and following bundle implementation, we embedded a critical care flowsheet in the EHR that incorporates ABCDE processes into the clinical workflow and allows for expedited capture of the performance of ABCDE care processes, sedation levels, and incidence of delirium. Recognizing that real-time information is needed to identify gaps in patient care and improve bundle adoption, we have also leveraged the EHR to develop a dashboarding tool that allows ICU managers to pull data regarding bundle compliance from the critical care flowsheet, monitor key performance indicators, and provide feedback to frontline staff.

Innovation

The creation of the critical care flowsheet and the associated performance reporting tool allows for measurement and concurrent intervention (“measure-vention”) to address gaps in the delivery of evidenced-based care processes for delirium prevention/mitigation and accelerate bundle adherence. Currently, most quality and safety data are still derived from retrospective and labor-intensive sampling of patient populations via manual chart review and shared months after the care processes of interest have been performed. The measure-vention tactics deployed in this project allow for use of EHR data to improve patient care at the point of maximal benefit-while they are still in the hospital.

Discussion

Valuable data regarding delivery of care and patient outcomes are often contained within EHRs but are difficult to abstract in a timely and efficient manner. By creating a critical care flowsheet in the EHR to facilitate delivery of a care bundle for delirium prevention and collect data regarding bundle adherence and creating a reporting tool that enables real-time performance feedback, we are building a learning health system and a generalizable framework for the identification of current gaps in care and the simultaneous collection of data that will be useful for comparative effectiveness and patient-centered outcomes research.

Next Steps

Following implementation of the performance reporting tool, we will abstract patient outcomes data from the EHR to determine bundle adherence rates and the effect of bundle implementation on patient outcomes including incidence and duration of delirium, ventilator days, coma days, length of stay, nursing home utilization, and mortality.