The Effect of an Electronic Decision-Support Tool on Quality Outcomes in the Intensive Care Unit

2019 ◽  
Author(s):  
N. Tocci ◽  
A. Anderson ◽  
C. Curley ◽  
T. Dechen ◽  
S. Devlin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Decision Support ◽  
Decision Support Tool ◽  
Quality Outcomes ◽  
Electronic Decision Support ◽  
Support Tool

Using a Decision Wheel to Reduce Use of Restraints in a Medical-Surgical Intensive Care Unit

2016 ◽  
Vol 25 (6) ◽  
pp. 479-486 ◽  
Author(s):  
Stacy Hevener ◽  
Barbara Rickabaugh ◽  
Toby Marsh
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Decision Support ◽  
Intensive Care Units ◽  
Decision Support Tool ◽  
Educational Activity ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Support Tool ◽  
Unplanned Extubations

Background Little information is available on the use of tools in intensive care units to help nurses determine when to restrain a patient. Patients in medical-surgical intensive care units are often restrained for their safety to prevent them from removing therapeutic devices. Research indicates that restraints do not necessarily prevent injuries or removal of devices by patients. Objectives To decrease use of restraints in a medical-surgical intensive care unit and to determine if a decision support tool is useful in helping bedside nurses determine whether or not to restrain a patient. Methods A quasi-experimental study design was used for this pilot study. Data were collected for each patient each shift indicating if therapeutic devices were removed and if restraints were used. An online educational activity supplemented by 1-on-1 discussion about proper use of restraints, alternatives, and use of a restraint decision tool was provided. Frequency of restraint use was determined. Descriptive statistics and thematic analysis were used to examine nurses’ perceptions of the decision support tool. Results Use of restraints was reduced 32%. No unplanned extubations or disruption of life-threatening therapeutic devices by unrestrained patients occurred. Conclusions With implementation of the decision support tool, nurses decreased their use of restraints yet maintained patients’ safety. A decision support tool may help nurses who are undecided or who need reassurance on their decision to restrain or not restrain a patient.

scholarly journals Evaluation of a hypothetical decision-support tool for intensive care triage of patients with coronavirus disease 2019 (COVID-19)

2021 ◽  
Vol 6 ◽  
pp. 183
Author(s):  
Emily Simon Thomas ◽  
Bryony Peiris ◽  
Leon Di Stefano ◽  
Matthew J. Rowland ◽  
Dominic Wilkinson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Decision Support ◽  
Decision Support Tool ◽  
Clinical Frailty Scale ◽  
P Values ◽  
Support Tool ◽  
Resource Limitations ◽  
Treatment Limitation ◽  
Uk National Health Service

Background: At the start of the coronavirus disease 2019 (COVID-19) pandemic there was widespread concern about potentially overwhelming demand for intensive care and the need for intensive care unit (ICU) triage. In March 2020, a draft United Kingdom (UK) guideline proposed a decision-support tool (DST). We sought to evaluate the accuracy of the tool in patients with COVID-19. Methods: We retrospectively identified patients in two groups: referred and not referred to intensive care in a single UK national health service (NHS) trust in April 2020. Age, Clinical Frailty Scale score (CFS), and co-morbidities were collected from patients’ records and recorded, along with ceilings of treatment and outcome. We compared the DST, CFS, and age alone as predictors of mortality, and treatment ceiling decisions. Results: In total, 151 patients were included in the analysis, with 75 in the ICU and 76 in the non-ICU-reviewed groups. Age, clinical frailty and DST score were each associated with increased mortality and higher likelihood of treatment limitation (p-values all <.001). A DST cut-off score of >8 had 65% (95% confidence interval (CI) 51%-79%) sensitivity and 63% (95% CI 54%-72%) specificity for predicting mortality. It had a sensitivity of 80% (70%-88%) and specificity of 96% (95% CI 90%-100%) for predicting treatment limitation. The DST was more discriminative than age alone (p<0.001), and potentially more discriminative than CFS (p=0.08) for predicting treatment ceiling decisions. Conclusions: During the first wave of the COVID-19 pandemic, in a hospital without severe resource limitations, a hypothetical decision support tool was limited in its predictive value for mortality, but appeared to be sensitive and specific for predicting treatment limitation.

scholarly journals THE PRIMA-EDS ELECTRONIC DECISION SUPPORT TOOL FOR POLYPHARMACY: A MULTINATIONAL EUROPEAN PROJECT

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 1048-1048
Author(s):  
A. Renom Guiteras ◽  
I. Kunnamo ◽  
D. Reeves ◽  
J. Hoeck ◽  
G. Piccoliori ◽  
...  
Keyword(s):  
Decision Support ◽  
Decision Support Tool ◽  
Electronic Decision Support ◽  
Support Tool ◽  
European Project

scholarly journals Reduction of the long-term use of proton pump inhibitors by a patient-oriented electronic decision support tool (arriba-PPI): study protocol for a randomized controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Anja Rieckert ◽  
Annette Becker ◽  
Norbert Donner-Banzhof ◽  
Annika Viniol ◽  
Bettina Bücker ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Decision Support ◽  
Controlled Trial ◽  
Decision Support Tool ◽  
Routine Care ◽  
Electronic Decision Support ◽  
Support Tool ◽  
Randomized Controlled ◽  
Cluster Randomized

Abstract Background Proton pump inhibitors (PPIs) are increasingly being prescribed, although long-term use is associated with multiple side effects. Therefore, an electronic decision support tool with the aim of reducing the long-term use of PPIs in a shared decision-making process between general practitioners (GPs) and their patients has been developed. The developed tool is a module that can be added to the so-called arriba decision support tool, which is already used by GPs in Germany in routine care. In this large-scale cluster-randomized controlled trial we evaluate the effectiveness of this arriba-PPI tool. Methods The arriba-PPI tool is an electronic decision support system that supports shared decision-making and evidence-based decisions around the long-term use of PPIs at the point of care. The tool will be evaluated in a cluster-randomized controlled trial involving 210 GP practices and 3150 patients in Germany. GP practices will be asked to recruit 20 patients aged ≥ 18 years regularly taking PPIs for ≥ 6 months. After completion of patient recruitment, each GP practice with enrolled patients will be cluster-randomized. Intervention GP practices will get access to the software arriba-PPI, whereas control GPs will treat their patients as usual. After an observation period of six months, GP practices will be compared regarding the reduction of cumulated defined daily doses of PPI prescriptions per patient. Discussion Our principal hypothesis is that the application of the arriba-PPI tool can reduce PPI prescribing in primary care by at least 15% compared to conventional strategies used by GPs. A positive result implies the implementation of the arriba-PPI tool in routine care. Trial registration German Clinical Trials Register, DRKS00016364. Registered on 31 January 2019.

scholarly journals Using an Electronic Decision Support Tool to Reduce Inappropriate Polypharmacy and Optimize Medicines: Rationale and Methods

2016 ◽  
Vol 5 (2) ◽  
pp. e105 ◽  
Author(s):  
Amber Young ◽  
June Tordoff ◽  
Susan Dovey ◽  
David Reith ◽  
Hywel Lloyd ◽  
...  
Keyword(s):  
Decision Support ◽  
Decision Support Tool ◽  
Electronic Decision Support ◽  
Support Tool

scholarly journals Reduction of inappropriate medication in older populations by electronic decision support (the PRIMA-eDS project): a survey of general practitioners’ experiences

2019 ◽  
Vol 26 (11) ◽  
pp. 1323-1332 ◽  
Author(s):  
Anja Rieckert ◽  
Anne-Lisa Teichmann ◽  
Eva Drewelow ◽  
Celine Kriechmayr ◽  
Giuliano Piccoliori ◽  
...  
Keyword(s):  
Decision Support ◽  
Electronic Health Record ◽  
General Practitioners ◽  
Inappropriate Medication ◽  
Decision Support Tool ◽  
Health Record ◽  
Electronic Decision Support ◽  
Support Tool ◽  
Electronic Health ◽  
Older Populations

Abstract Objective We sought to investigate the experiences of general practitioners (GPs) with an electronic decision support tool to reduce inappropriate polypharmacy in older patients (the PRIMA-eDS [Polypharmacy in chronic diseases: Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support] tool) in a multinational sample of GPs and to quantify the findings from a prior qualitative study on the PRIMA-eDS-tool. Materials and Methods Alongside the cluster randomized controlled PRIMA-eDS trial, a survey was conducted in all 5 participating study centers (Bolzano, Italy; Manchester, United Kingdom; Salzburg, Austria; Rostock, Germany; and Witten, Germany) between October 2016 and July 2017. Data were analyzed using descriptive statistics and chi-square tests. Results Ninety-one (n = 160) percent of the 176 questionnaires were returned. Thirty-two percent of the respondents reported that they did not cease drugs because of the medication check. The 68% who had discontinued drugs comprise 57% who had stopped on average 1 drug and 11% who had stopped 2 drugs or more per patient. The PRIMA-eDS tool was found to be useful (69%) and the recommendations were found to help to increase awareness (86%). The greatest barrier to implementing deprescribing recommendations was the perceived necessity of the medication (69%). The majority of respondents (65%) would use the electronic medication check in routine practice if it was part of the electronic health record. Conclusions GPs generally viewed the PRIMA-eDS medication check as useful and as informative. Recommendations were not always followed due to various reasons. Many GPs would use the medication check if integrated into the electronic health record.

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