Clinical trial NCT04845698: i-Dashboard for Multi-disciplinary Rounds in SICU
Official title: Application of i-Dashboard for Multi-disciplinary Rounds in Surgical Intensive Care Units
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Workflow
Communication
Quality of Health Care
Keywords: Electronic Health Records
User-Computer Interface
Intensive Care Units
Patient Care Team
Teaching Rounds
Lead sponsor: National Cheng-Kung University Hospital
Sponsor class: OTHER
First posted: 2021-04-15
Enrollment: 144
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Intervention model description: A cluster randomized trial was conducted in two surgical intensive care units (ICUs) of the hospital. For each two-week period of the trial, participating ICUs (cluster) were assigned to multi-disciplinary rounds with i-Dashboard (intervention) or without i-Dashboard (control). In other words, the two ICUs were randomly assigned to multi-disciplinary rounds with i-Dashboard during the first two weeks, without i-Dashboard during the second two weeks, and with i-Dashboard during the third two weeks or vice versa.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Background: Information overload is a common problem in intensive care units. A display tool that facilitates retrieval of crucial clinical information from electronic medical records has excellent potential to attenuate information overload and benefit workflow.

Study hypothesis: In this project, we aimed to evaluate the efficacy and clinical satisfaction of a team-designed, patient-centered electronic medical record viewer, i-Dashboard, to facilitate multi-disciplinary rounds in our surgical intensive care units.

Detailed description: Background: More than 5.7 million people are admitted into intensive Care Units (ICUs) in the United States each year. The ICU level of care that helps people with a life-threatening illness is provided by a multi-disciplinary team of specially-trained healthcare providers. These patients require more frequent assessment compared to those who do not need critical care. Essential parameters in the ICU settings include, but not limit to, vital sign monitoring, laboratory data, ventilator settings and vasoactive drugs. Therefore, information overload is a common problem in ICUs. Caring for ICU patients generates approximately 1200 data points per patient per day. The use of electronic medical records (EMRs) increases the data accuracy compared to handwritten notes. An effective management strategy for patient information in ICUs may be needed for clinicians to avoid being overwhelmed by data overload.

Data overload in ICUs may result in communication failures, possibly in association with worse patient outcomes. A delay between condition onsets and the beginning of therapeutic interventions may dramatically impact the prognosis of patients with sepsis or cardiopulmonary emergencies. Although EMR use has been increasingly adopted worldwide, whether EMRs are being used effectively and efficiently to enhance clinical workflow in ICUs remains a question. A large cross-sectional study of primary care practitioners have investigated the predictors of missed test results in the setting of EMR alerts. Of the 2590 responders, 86.9% perceived the quantity of alerts they received to be excessive, 69.6% reported receiving more alerts than they could effectively manage (a marker of information overload), 55.6% reported that the current EMR notification system made it possible for practitioners to miss test results, and 29.8% reported having personally missed test results that led to care delays. These results suggested that primary care practitioners using comprehensive EMRs are vulnerable to information overload, leading them to miss important information. To address the nature of the high volume of metrics monitored and the urgent responses to patients' condition changes in ICUs, a display tool that facilitates retrieval of crucial clinical information has excellent potential to attenuate information overload and benefit workflow.

Visualization transforms data into visual representations, making the cognitive processing of data more effective and efficient. The use of visualization techniques in the clinical setting provides an overview to improve display and recognition of patients' conditions, potentially reducing cognitive overload among specially-trained healthcare providers. A dashboard is a data-driven clinical decision support tool capable of retrieving data from multiple databases and providing a quick representation of key metrics for each patient. The utility of a dashboard comes from its ability to provide a concise overview of crucial information. In addition to being designed based on user experiences, a dashboard for clinical use should be designed based on several proposed principles, including 1) one view should contain single patient data, 2) data should be summarized or titled for overview and details should be given on-demand, 3) data should be displayed in time-series, 4) data should be categorized by primary type, and 5) more data should be displayed at the same time. While being applied to the ICU settings, a dashboard may allow healthcare providers in a multi-disciplinary team to identify patients' active problems that need prompt interventions.

Hypothesis and Specific Aims: The implementation of multi-disciplinary rounds in ICUs exhibits a positive effect on both patient care outcome and staff satisfaction with team dynamics. In Taiwan, multi-disciplinary ICU rounds have been an important item to be evaluated in hospital accreditation. The study participants include ICU healthcare providers, i.e. physicians, nurse practitioners, nurses, respiratory therapists, pharmacists and dietitians. In this project, we aimed to evaluate the efficacy and clinical satisfaction of a team-designed, patient-centered electronic medical record viewer, i-Dashboard, to facilitate multi-disciplinary rounds in our surgical intensive care units. To achieve these research goals the applicant proposed studies with the following specific aims:

1. The use of i-Dashboard reduces time spent on pre-round data gathering.
2. The use of i-Dashboard increases communication accuracy during multi-disciplinary ICU rounds, including vital signs, catheters, laboratory data, medications, input/output balance and warnings on redline values.
3. The use of i-Dashboard enhances recommendations actively made by multi-disciplinary team members, including respiratory therapists, pharmacists and dietitians.
4. The use of i-Dashboard enhances healthcare provider satisfaction, as evaluated by questionnaires modified from previous studies.

Eligibility criteria: Inclusion Criteria:

* Patients admitted into the two surgical intensive care units for more than 7 days

Exclusion Criteria:

* None

Primary outcomes:
measure: Time spent on pre-round data gathering (minutes)
timeFrame: 3 hours
measure: Communication accuracy during multi-disciplinary ICU rounds (number of data misrepresentation)
timeFrame: 3 hours
Secondary outcomes:
measure: Enhancement of care quality and patient safety during multi-disciplinary ICU rounds (number of recommendations from multi-disciplinary team members)
timeFrame: 3 hours
measure: Healthcare provider satisfaction (questionnaire)
timeFrame: 3 months
Other outcomes:
Locations:
city: Tainan City
country: Taiwan
facility: National Cheng Kung University Hospital
state: Taiwan, R.o.c
Study officials:
affiliation: National Cheng-Kung University Hospital
name: Chao-Han Lai, MD, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: National Cheng-Kung University Hospital
name: Meng-Ru Shen, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Pickering BW, Dong Y, Ahmed A, Giri J, Kilickaya O, Gupta A, Gajic O, Herasevich V. The implementation of clinician designed, human-centered electronic medical record viewer in the intensive care unit: a pilot step-wedge cluster randomized trial. Int J Med Inform. 2015 May;84(5):299-307. doi: 10.1016/j.ijmedinf.2015.01.017. Epub 2015 Jan 31.
citation: Artis KA, Dyer E, Mohan V, Gold JA. Accuracy of Laboratory Data Communication on ICU Daily Rounds Using an Electronic Health Record. Crit Care Med. 2017 Feb;45(2):179-186. doi: 10.1097/CCM.0000000000002060.
citation: Khairat SS, Dukkipati A, Lauria HA, Bice T, Travers D, Carson SS. The Impact of Visualization Dashboards on Quality of Care and Clinician Satisfaction: Integrative Literature Review. JMIR Hum Factors. 2018 May 31;5(2):e22. doi: 10.2196/humanfactors.9328.
citation: Lai CH, Li KW, Hu FW, Su PF, Hsu IL, Huang MH, Huang YT, Liu PY, Shen MR. Integration of an Intensive Care Unit Visualization Dashboard (i-Dashboard) as a Platform to Facilitate Multidisciplinary Rounds: Cluster-Randomized Controlled Trial. J Med Internet Res. 2022 May 13;24(5):e35981. doi: 10.2196/35981.