Sustained Reduction of Ventilator-Associated Pneumonia Rates Using Real-Time Course Correction With a Ventilator Bundle Compliance Dashboard

Talbot, Thomas R.; Carr, Devin; Parmley, C. Lee; Martin, Barbara J.; Gray, Barbara; Ambrose, Anna; Starmer, Jack

doi:10.1017/ice.2015.180

Cited by 30 publications

(41 citation statements)

References 21 publications

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“…While having demonstrated efficacy in other industries, dashboards are still in their nascent form in healthcare, and fundamental questions remain on how to best apply this tool. While dashboards have been used by hospital management primarily for financial,34 operational2 or compliance measures,35 36 their use in improving clinician performance have been mainly at a patient level37 or at the facility/unit level 38–40…”

Section: Discussionmentioning

confidence: 99%

Variable effectiveness of stepwise implementation of nudge-type interventions to improve provider compliance with intraoperative low tidal volume ventilation

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Variable effectiveness of stepwise implementation of nudge-type interventions to improve provider compliance with intraoperative low tidal volume ventilation

et al. 2018

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“…In another case, Welch et al (2015) [42] adopted a diabetic dashboard to promote HC efficiency in diabetic care, in the designed dashboard they put different data, such as patient demographic data, medication types etc. In eight other studies, dashboards were used to improve the adherence to various guidelines in HC organizations [6], [7], [44]- [49]. For example, dashboards were used to monitor adherence to ventilator bundle in intensive care unit [6], [49] and to prevent infection in the adult Intensive Care [7].…”

Section: Objects Of Dashboards Use In Healthcarementioning

confidence: 99%

“…In eight other studies, dashboards were used to improve the adherence to various guidelines in HC organizations [6], [7], [44]- [49]. For example, dashboards were used to monitor adherence to ventilator bundle in intensive care unit [6], [49] and to prevent infection in the adult Intensive Care [7]. Some other groups of HC organizations applied dashboards to fulfil their needs for real-time tracking and access to data [4], [50]- [53].…”

Section: Objects Of Dashboards Use In Healthcarementioning

confidence: 99%

“…Source Primary care practitioner [40]- [42], [45], [47]- [49], [52] General Practitioner [34] Clinician [9], [17]- [21], [31], [46], [50], [55], [56], [58], [59] Physician [5], [35], [39], [42], [44], [53] Nurse [4], [33], [36], [38], [42], [50] Medical Staff [4], [6], [7], [19], [21], [33], [37], [39], [43], [50], [51], [57] Pharmacist [40], [60] Administrator and Managers [36], [53], [57] Patient [4], [17]- [21], [52],…”

Section: Usersmentioning

confidence: 99%

“…Comparing [5], [36], [45], [46], [49], [54] Drilling [41], [45], [48], [51] Filtering [17], [33]- [35], [40], [41], [50], [54] Selecting [17], [35], [36], [40], [48], [50], [51] Zooming [33]- [35] Translating [17]…”

Section: Identified Tasksmentioning

confidence: 99%

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Investigating Analytics Dashboards’ Support for the Value-based Healthcare Delivery Model

Mashinchi¹,

Ojo²,

Sullivan³

2020

Proceedings of the Annual Hawaii International Conference on System Sciences

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Improving the value of care is one of the essential aspects of Value-Based Healthcare (VBHC) model today. VBHC is a new HC delivery model which is centered on patient health outcomes and improvements. There is anecdotal evidence that the use of decision aid tools like dashboards can play a significant role in the successful implementation of VBHC models. However, there has been little or no systematic studies and reviews to establish the extent to which analytics dashboards are used to support patient care in a VBHC delivery context. This paper bridges this knowledge gap through a systematic review of the existing literature on dashboards in the HC domain. Our study reveals dashboard capabilities as an enabling tool for value improvements and provides insight into the design of dashboards. This study concludes by highlighting a few gaps, question, and need for research in the future.The need for HC services is rising due to growing global demand and population, the burden of increasingly complicated chronic disease [8]. With

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Associations Between Ventilator Bundle Components and Outcomes

et al. 2016

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IMPORTANCE Ventilator bundles, including head-of-bed elevation, sedative infusion interruptions, spontaneous breathing trials, thromboprophylaxis, stress ulcer prophylaxis, and oral care with chlorhexidine gluconate, are ubiquitous, but the absolute and relative value of each bundle component is unclear. OBJECTIVE To evaluate associations between individual and collective ventilator bundle components and ventilator-associated events, time to extubation, ventilator mortality, time to hospital discharge, and hospital death. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included all 5539 consecutive patients who underwent mechanical ventilation for at least 3 days from January 1, 2009, to December 31, 2013, at Brigham and Women's Hospital. EXPOSURES Head-of-bed elevation, sedative infusion interruptions, spontaneous breathing trials, thromboprophylaxis, stress ulcer prophylaxis, and oral care with chlorhexidine. MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) for ventilator-associated events, extubation alive vs ventilator mortality, and hospital discharge vs hospital death. Effects were modeled using Cox proportional hazards regression and Fine-Gray competing risk models adjusted for patients' demographic characteristics, comorbidities, unit type, severity of illness, recent procedures, process measure contraindications, day-today markers of clinical status, and calendar year. RESULTS Of 5539 consecutive patients undergoing mechanical ventilation, 3208 were male (57.9%), 2331 female (42.1%), and the mean (SD) age was 61.2 (16.1) years. Sedative infusion interruptions were associated with less time to extubation (HR, 1.81; 95% CI, 1.54-2.12; P < .001) and a lower hazard for ventilator mortality (HR, 0.51, 95% CI, 0.38-0.68; P < .001). Similar associations were found for spontaneous breathing trials (HR for extubation, 2.48; 95% CI 2.23-2.76; P < .001; HR for mortality, 0.28; 95% CI, 0.20-0.38; P = .001). Spontaneous breathing trials were also associated with lower hazards for ventilatorassociated events (HR, 0.55; 95% CI, 0.40-0.76; P < .001). Associations with less time to extubation were found for head-of-bed elevation (HR, 1.38, 95% CI, 1.14-1.68; P = .001) and thromboembolism prophylaxis (HR, 2.57; 95% CI, 1.80-3.66; P < .001) but not ventilator mortality. Oral care with chlorhexidine was associated with an increased risk for ventilator mortality (HR, 1.63; 95% CI, 1.15-2.31; P = .006), and stress ulcer prophylaxis was associated with an increased risk for ventilator-associated pneumonia (HR, 7.69; 95% CI, 1.44-41.10; P = .02). CONCLUSIONS AND RELEVANCE Standard ventilator bundle components vary in their associations with patient-centered outcomes. Head-of-bed elevation, sedative infusion interruptions, spontaneous breathing trials, and thromboembolism prophylaxis appear beneficial, whereas daily oral care with chlorhexidine and stress ulcer prophylaxis may be harmful in some patients.

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Sustained Reduction of Ventilator-Associated Pneumonia Rates Using Real-Time Course Correction With a Ventilator Bundle Compliance Dashboard

Abstract: 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.

Cited by 30 publications

References 21 publications

Variable effectiveness of stepwise implementation of nudge-type interventions to improve provider compliance with intraoperative low tidal volume ventilation

Variable effectiveness of stepwise implementation of nudge-type interventions to improve provider compliance with intraoperative low tidal volume ventilation

Investigating Analytics Dashboards’ Support for the Value-based Healthcare Delivery Model

Associations Between Ventilator Bundle Components and Outcomes

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