improving accessibility of key information during ... · lor # = level of reliability number, e.g.,...

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

Disclosures

The authors have no financial relationships to

disclose or conflicts of interest to resolve.

Background:ED Resuscitations

Background

Team leading during resuscitations

• High cognitive load

• Situational awareness

• Communication

Current System

Improve access to key data during resuscitation

Project Goal

Requirements of Solution

• Leverage existing technology

• Display key data from multiple sources

• Easily visible / digestible format

• Require minimal (or no) user interaction

Test System

Capabilities – Front Screen

Front Screen Capabilities

Front Screen –

Video Laryngoscope Output

Rear Screen Capabilities

Study Objective

Assess provider perception of accessibility of key

data prior to and after implementation of the large

screen electronic dashboard

Methods

• Setting

– Resuscitation suite

– High volume ED

– Large, tertiary care children’s hospital

• Patients

– Critically ill

– Medical and Traumatic etiologies

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

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

• 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

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

• 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

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

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.

Next Steps

• Improving our solution

• Install in remaining resuscitation bays?

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

Questions

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

Our Team

• Multidisciplinary input

– PEM physician

– Experienced RN team leader

– EPIC analyst

– Trauma services RN

– Quality improvement experts

– Parent Advisory Committee

Perceived importance of Key Data

Reasons for Perceived importance

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%)

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

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

Resuscitation Suite Documentation

• Electronic Medical Record

– November 2012

• Improved documentation (more detailed)

• Negative effect on RN team leader’s capacity to co-team

lead