Automated intra-operative SMS message updates: a quality improvement initiative to relieve caregivers’ worries (Preprint)

BACKGROUND Undergoing a surgical procedure is anxiety provoking for patients and their caregivers. During the intra-operative period, caregivers seek out informational updates from healthcare professionals, a situation complicated by COVID-19 health measures that require caregivers to wait outside the hospital. SMS-based communication that allows caregivers to follow their loved ones through surgery has shown promise in relieving anxiety and improving satisfaction with overall care. This form of communication is also well accepted by healthcare professionals and may be effective at relieving staff burden. OBJECTIVE Here we describe a quality improvement initiative of a standardized and integrated intra-operative SMS-based system to improve communication between surgical teams and caregivers. The main goal was to reduce caregiver anxiety; secondary goals included improving satisfaction with care and not increasing staff burden. METHODS A large tertiary care hospital offered the SMS service to caregivers who were waiting for loved ones undergoing surgery. SMS messages were integrated into the clinical information system software and sent at key points during the surgical journey to phone numbers provided by caregivers. A satisfaction survey was sent to caregivers one business day after surgery. Data were collected between Feb 16th and July 14th 2021. RESULTS Of the 8,129 surgeries scheduled, caregivers waiting for 6,149 surgeries (76%) agreed to receive SMS messages. A total of 34,129 messages were sent. The satisfaction survey was completed by 2,088/6,149 or 34 % of caregivers. Satisfaction with messages was high, with the majority of respondents reporting the messages received were adequate (71%), clear (74%), informative (72%) and met their needs (60%). Receiving text messages reduced caregiver anxiety (score 8.5 out of 10) and the overall satisfaction score was high (4.5 out of 5). Technical errors were reported by 111 caregivers. Suggestions for improvements included having messages sent more often, providing greater patient detail and being offered in other languages. CONCLUSIONS This digital health initiative provided SMS messages that were standardized and systematically sent to caregivers waiting for their loved ones undergoing surgery. This in turn decreased caregiver anxiety, with no additional burden to staff. In creating digital healthcare innovations, what patients and their families find useful and appreciated will ultimately determine uptake. Thus, caregiver feedback will inform future iterations of this initiative.

Acute cardiac side effects after COVID-19 mRNA vaccination, a case series

Background: Since development and approval of the world´s first mRNA vaccines, created under pressure of the global pandemic caused by SARS-CoV-2, potential side effects have naturally been a much-debated topic. Vaccination may be one, if not the only way out of the pandemic claiming more than 4 million deaths worldwide to date. Potential side effects from vaccination have long been controversial, and case reports of fatal side effects have been published. Therefore, data are needed to identify persons being at high risk for potential side effects. Until September 30, 2021, 1.243 cases of myocarditis after vaccination with BNT162b2 Comirnaty© in young adults were registered by the Paul-Ehrlich-Institute in Germany alone. The exact pathophysiology and the risk factors for myocarditis following vaccination remain unclear. We present a case series of eight patients with cardiac symptom shortly after SARS-CoV-2 mRNA vaccination (BNT162b6, Biontech, Comirnaty© or mRNA-1237 Moderna, Spikevax©).Patients and Methods: Eight patients between 13-56 years of age, vaccinated with mRNA vaccine either BNT162b2 or mRNA-1273 between January and August 2021 developed cardiac side effects shortly after either their first or second vaccination. Clinical data were retrieved from the clinical information system and analyzed. To support diagnosis of myocarditis or pericarditis, cardiac magnetic resonance imaging (MRI) was performed shortly after onset of symptoms and investigated further in severe cases. Symptoms were defined as dyspnea, chest pain, cardiac arrhythmia as determined by electrocardiography.Results: Eight patients (five males and three females) developed cardiac symptoms compatible with myocarditis according to CDC criteria shortly after SARS-CoV-2 mRNA vaccination. Three patients (two males, one female) required hospitalization due to severe chest pain and elevated troponin levels. All patients recovered fully within seven days after symptom onset Conclusion: Our data suggest that cardiac adverse events such as myocarditis or pericarditis shortly after SARS-CoV-2 mRNA vaccination are rare but possible and occur particularly in male patients.

Chios Hospital Information System Assessment

A very important aspect for organizations that provide healthcare services is to have fully functional and successful information systems. A successful hospital information system can contribute to high quality healthcare services provided to the patients of the hospital. In this paper, is presented the evaluation of the information system of Chios Hospital, “Skylitsio”. The survey was conducted using a questionnaire which consists demographic questions and questions that measure the factors of the DeLone & McLean success model. The participants of the survey were 71 users of the clinical information system. Cronbach’s alpha reliability test, descriptive statistics, and further data analyses to investigate the relations between the factors of the DeLone & McLean success model were performed. Based on the results, the users of the information system are satisfied with it, as well as they find the system useful and easy to use. The average value of the “information quality” is 3.78 out of 5, the “system quality” is 3.61, the “service quality” is 3.45, the “use” is 3.83, the “user satisfaction” is 3.46, and the “user benefit” is 3.76. The research concludes with a validation of the DeLone & McLean success model and it seems that the information system of the General Hospital of Chios is successful based on the users’ opinions.

Factors Affecting Adherence to Early Mobilization in an Intensive Care Unit: An Analysis of Data Collected Prospectively Over a Three-Year Period by Clinical Information System

Background: Early mobilization benefits critically ill patients. Scant information is available about adherence to early mobilization protocols in intensive care units (ICU). With the aim of optimizing the application of our early mobilization protocol in mechanically ventilated patients in routine daily practice, this study analyzed adherence to the protocol, impediments to adherence, and adverse eventsin our ICU. Methods: This observational study analyzed data collected prospectively at a 24-bed polyvalent ICU over a three-year period (2017–2019). Data from adult patients on mechanical ventilation > 48 hours who met the inclusion criteria for the early mobilization protocol were included. We analyzed demographics, adherence to the protocol, total number of mobilizations, impediments to early mobilization, artificial airway/ventilatory support at each mobilization level, and adverse events during mobilization. All data was automatically obtained from the clinical information system by extract, transform, and load processes using Python 3.0. The unit of analysis was ICU stay-day. Results: We analyzed 3269 stay-days from 388 patients with median age of 63 (51–72) years, median APACHE II 23 (18–29) and median ICU stay of 10.1 (6.2–16.5) days. Adherence to the protocol was 56.6% (1850 stay-days), but patients were mobilized in only 32.2% (1472) of all stay-days. The most common reasons for not mobilizing patients were failure to meeting the criteria for clinical stability in 241 (42%) stay-days and unavailability of physiotherapists in 190 (33%) stay-days. Adverse events occurred in only 6 (0.4%) stay-days mobilizations. Conclusions: Although adherence to the protocol was high, patients were mobilized in only one-third of all stay-days. This study points to ways we can improve early mobilization in our ICU, including assessing the suitability of the criteria for clinical stability and increasing the presence of physiotherapists.

Restoring clinical information system operations post data disaster: the role of IT investment, integration and interoperability

PurposeDelay in the clinical information system (CIS) restoration overseeing critical health-care operations after an unexpected data loss can be fatal for patients under care. Investment in information technology (IT) capabilities and synergy between various computerized systems has been argued as the resilient information system's enablers. The purpose of this study is to empirically quantify the influence of IT investment, integration and interoperability in recovering the CIS from a data disaster.Design/methodology/approachAn archival dataset sourced from a European Commission-sponsored survey of 773 hospitals across 30 countries in Europe is utilized to study the relationships. The study adopts a quasi-experimental research design approach where sample observations are weighted based on their propensity to be selected in treatment groups. The artificial weighing allows attaining a pseudo-random sample to counter the effects of selection bias.FindingsThe study finds that hospitals with more than 5% of the budget dedicated to IT have 100% higher odds of recovering immediately from a critical data loss in comparison to those that have less than 1% investment in IT. The greater extent of IT integration significantly reduces the time to recover the CIS, while interoperability problems at the organizational level lessen the odds of immediate recovery by 19%. Interoperability problems at the technical and semantic levels do not significantly impact recovery times of the CIS.Originality/valueThe study proposes several empirically quantified and scientifically tested recommendations for health-care providers for faster restoration of critical CIS operations post data loss. The differential impact of the interoperability problems at the technical, semantic and organizational levels has also been highlighted.

Health service clinical information system after kidney transplantation, from the perspective of users and professionals

Objetivo: analisar a organização, o registro e o armazenamento dos dados clínicos das pessoas após o transplante renal nos serviços de saúde. Métodos: estudo qualitativo realizado entre o primeiro e o segundo semestre de 2016, com transplantados renais, profissionais e gestores, totalizando 30 participantes. Os dados coletados foram entrevistas individuais gravadas em áudio, transcritas em meio digital e organizados no software Etnography, para serem analisadas a partir de uma análise de conteúdo dirigida. Resultados: os participantes explicaram os tipos existentes de prontuários, que depois da realização do transplante renal são arquivados pelo serviço de nefrologia onde a pessoa realizava o tratamento dialítico. Porém, em casos de retorno à diálise pela falência do órgão transplantado, participantes referiram a organização do serviço para o registro de informações sobre o atendimento. Já no centro transplantador, os participantes mencionaram como ocorrem os registros das intercorrências no estado de saúde, dos resultados de exames laboratoriais e das orientações transmitidas. Conclusão: a utilização de ferramentas e de instrumentos na organização, no registro e no armazenamento dos dados clínicos, durante a assistência à pessoa, auxilia os profissionais da saúde na tomada de decisão sobre o cuidado a ser prestado e facilita a troca de informações, proporcionando qualidade...

Investigating the Success of “Asklepieio Voulas” Hospital Information System

Hospital Information Systems assessment is important to ensure the quality of provided healthcare services. This research evaluates the success of the clinical information system used in the General Hospital “Asklepieio Voulas”. A questionnaire was developed based on the DeLone & McLean information systems success model, and used on February 2020, to record the users’ opinions regarding the information system. The reliability of the questionnaire was tested by applying Cronbach’s alpha analysis, descriptive statistics was calculated for all variables of the questionnaire, and new variables was created to investigate the relationships between the model’s factors. Correlation analysis between the factors and linear multiple regression analysis between some of the factors of the DeLone & McLean success model were conducted 218 users responded to the survey, 56.3% of them were medical doctors, 24.1% nurses, and 19.6% other staff of the hospital. Results highlight that the users of the system are satisfied with it. A77.3% of the participants believe that they perform their work more easily when using the system, while 89.3% of the participants believe that the system is useful in their work. According to the results of the model, system quality and information quality seems to be related with the system usage. Information quality plays the most important role in the use of the system while the system quality plays the most important role in user satisfaction. Based on the users’ opinions, the “Asklepieio Voulas” Hospital Information System can be assumed as successful.

How Unexpected Is Out-of-hospital Sudden Cardiac Arrest? A Retrospective Cohort Study

BackgroundApproximately 100,000 patients suffer from sudden cardiac arrest (CA) annually in Germany. The causes for CA are cardiac in 75% of these cases. The present study aims to investigate the medical prehistory of patients who suffered from out-of-hospital cardiac arrest (OHCA) in a town with 250,000 inhabitants during 5 years and how many of these patients had already been previously treated at the local cardiac arrest center (CAC).Case presentationAll resuscitations due to OHAC were retrospectively analyzed for the cause of OHCA, preexisting cardiac conditions and treatment, lay resuscitation, and outcome from January 1, 2012, to December 31, 2016, in Aachen, Germany. Data analysis was based on the resuscitation protocols and data from the CAC clinical information system. More than 50% of the patients with CA from cardiovascular origin were already known at the receiving respective CAC. Almost 60% of all patients already had cardiac preexisting conditions. Nevertheless, lay resuscitation occurred in only 34.1% of all cases. It was not performed in more than 60% although the probability of discharge can be significantly increased by lay resuscitation.ConclusionThe rate of lay resuscitation is relatively low although many patients suffering from CA have cardiac preexisting conditions. These findings show the importance of better priming their relatives for emergencies to improve lay resuscitation and improve the chances for a better outcome.