Objective: Computer-aided decision tools may speed recognition of acute respiratory distress syndrome (ARDS) and promote consistent, timely treatment using lung-protective ventilation (LPV). This study evaluated implementation and service (process) outcomes with deployment and use of a clinical decision support (CDS) synchronous alert tool associated with existing computerized ventilator protocols and targeted patients with possible ARDS not receiving LPV. Materials and Methods: We performed an explanatory mixed methods study from December 2019 to November 2020 to evaluate CDS alert implementation outcomes across 13 intensive care units (ICU) in an integrated healthcare system with >4000 mechanically ventilated patients annually. We utilized quantitative methods to measure service outcomes including CDS alert tool utilization, accuracy, and implementation effectiveness. Attitudes regarding the appropriateness and acceptability of the CDS tool were assessed via an electronic field survey of physicians and advanced practice providers. Results: Thirty-eight percent of study encounters had at least one episode of LPV nonadherence. Addition of LPV treatment detection logic prevented an estimated 1812 alert messages (41%) over use of disease detection logic alone. Forty-eight percent of alert recommendations were implemented within 2 h. Alert accuracy was estimated at 63% when compared to gold standard ARDS adjudication, with sensitivity of 85% and positive predictive value of 62%. Fifty-seven percent of survey respondents observed one or more benefits associated with the alert. Conclusion: Introduction of a CDS alert tool based upon ARDS risk factors and integrated with computerized ventilator protocol instructions increased visibility to gaps in LPV use and promoted increased adherence to LPV.
Objective: Computer-aided decision tools may speed recognition of acute respiratory distress syndrome (ARDS) and promote consistent, timely treatment using lung-protective ventilation (LPV). This study evaluated implementation and service (process) outcomes with deployment and use of a clinical decision support (CDS) synchronous alert tool associated with existing computerized ventilator protocols and targeted patients with possible ARDS not receiving LPV. Materials and Methods: We performed an explanatory mixed methods study from December 2019 to November 2020 to evaluate CDS alert implementation outcomes across 13 intensive care units (ICU) in an integrated healthcare system with >4000 mechanically ventilated patients annually. We utilized quantitative methods to measure service outcomes including CDS alert tool utilization, accuracy, and implementation effectiveness. Attitudes regarding the appropriateness and acceptability of the CDS tool were assessed via an electronic field survey of physicians and advanced practice providers. Results: Thirty-eight percent of study encounters had at least one episode of LPV nonadherence. Addition of LPV treatment detection logic prevented an estimated 1812 alert messages (41%) over use of disease detection logic alone. Forty-eight percent of alert recommendations were implemented within 2 h. Alert accuracy was estimated at 63% when compared to gold standard ARDS adjudication, with sensitivity of 85% and positive predictive value of 62%. Fifty-seven percent of survey respondents observed one or more benefits associated with the alert. Conclusion: Introduction of a CDS alert tool based upon ARDS risk factors and integrated with computerized ventilator protocol instructions increased visibility to gaps in LPV use and promoted increased adherence to LPV.
Authors: Giacomo Bellani; John G Laffey; Tài Pham; Eddy Fan; Laurent Brochard; Andres Esteban; Luciano Gattinoni; Frank van Haren; Anders Larsson; Daniel F McAuley; Marco Ranieri; Gordon Rubenfeld; B Taylor Thompson; Hermann Wrigge; Arthur S Slutsky; Antonio Pesenti Journal: JAMA Date: 2016-02-23 Impact factor: 56.272
Authors: Curtis H Weiss; David W Baker; Katrina Tulas; Shayna Weiner; Meagan Bechel; Alfred Rademaker; Angela Fought; Richard G Wunderink; Stephen D Persell Journal: Ann Am Thorac Soc Date: 2017-11
Authors: Erick H Duan; Neill K J Adhikari; Frederick D'Aragon; Deborah J Cook; Sangeeta Mehta; Waleed Alhazzani; Ewan Goligher; Emmanuel Charbonney; Yaseen M Arabi; Tim Karachi; Alexis F Turgeon; Lori Hand; Qi Zhou; Peggy Austin; Jan Friedrich; Francois Lamontagne; François Lauzier; Rakesh Patel; John Muscedere; Richard Hall; Pierre Aslanian; Thomas Piraino; Martin Albert; Sean M Bagshaw; Mike Jacka; Gordon Wood; William Henderson; Delbert Dorscheid; Niall D Ferguson; Maureen O Meade Journal: Ann Am Thorac Soc Date: 2017-12
Authors: Nils Kucher; Sophia Koo; Rene Quiroz; Joshua M Cooper; Marilyn D Paterno; Boris Soukonnikov; Samuel Z Goldhaber Journal: N Engl J Med Date: 2005-03-10 Impact factor: 91.245
Authors: Michael J Lanspa; Ithan D Peltan; Jason R Jacobs; Jeffrey S Sorensen; Lori Carpenter; Jeffrey P Ferraro; Samuel M Brown; Jay G Berry; Raj Srivastava; Colin K Grissom Journal: Crit Care Date: 2019-12-27 Impact factor: 19.334