Improvements in data quality for decision support in intensive care

Nowadays, there is a plethora of technology in hospitals and, in particular, in intensive care units. The clinical data produced everyday can be integrated in a decision support system in real-time to improve quality of care of the critically ill patients. However, there are many sensitive aspects that must be taken into account, mainly the data quality and the integration of heterogeneous data sources. This paper presents INTCare, an Intelligent Decision Support System for Intensive Care in real-time and addresses the previous aspects, in particular, the development of an Electronic Nursing Record and the improvements in the quality of monitored data.Fundação para a Ciência e a Tecnologia (FCT

Enabling ubiquitous data mining in intensive care: Features selection and data pre-processing

Ubiquitous Data Mining and Intelligent Decision Support Systems are gaining interest by both computer science researchers and intensive care doctors. Previous work contributed with Data Mining models to predict organ failure and outcome of patients in order to support and guide the clinical decision based on the notion of critical events and the data collected from monitors in real-time. This paper addresses the study of the impact of the Modified Early Warning Score, a simple physiological score that may allow improvements in the quality and safety of management provided to surgical ward patients, in the prediction sensibility. The feature selection and data pre-processing are also detailed. Results show that for some variables associated to this score the impact is minimal.Fundação para a Ciência e a Tecnologia (FCT

End-of-life care in a pediatric intensive care unit: the impact of the development of a palliative care unit

Background: The purpose of this paper is to describe how end-of-life care is managed when life-support limitationis decided in a Pediatric Intensive Care Unit and to analyze the influence of the further development of the Palliative Care Unit. Methods: A 15-year retrospective study of children who died after life-support limitation was initiated in a pediatric intensive care unit. Patients were divided into two groups, pre- and post-palliative care unit development. Epidemiological and clinical data, the decision-making process, and the approach were analyzed. Data was obtained from patient medical records. Results: One hundred seventy-five patients were included. The main reason for admission was respiratory failure (86/175). A previous pathology was present in 152 patients (61/152 were neurological issues). The medical team and family participated together in the decision-making in 145 cases (82.8%). The family made the request in 10 cases (9 vs. 1, p = 0.019). Withdrawal was the main life-support limitation (113/175), followed by withholding lifesustaining treatments (37/175). Withdrawal was more frequent in the post-palliative group (57.4% vs. 74.3%, p = 0.031). In absolute numbers, respiratory support was the main type of support withdrawn. Conclusions: The main cause of life-support limitation was the unfavourable evolution of the underlying pathology. Families were involved in the decision-making process in a high percentage of the cases. The development of the Palliative Care Unit changed life-support limitation in our unit, with differences detected in the type of patient and in the strategy used. Increased confidence among intensivists when providing end-of-life care, and the availability of a Palliative Care Unit may contribute to improvements in the quality of end-of-life care

A value chain analysis of interventions to control production diseases in the intensive pig production sector

Value chain analysis (VCA) calculated the financial effects on food chain actors of interventions to improve animal health and welfare in the intensive pig sector. Two interventions to reduce production diseases were studied. A generic chain diagram of linkages between stakeholders and value-added dimensions was designed. Data on structure and financial performance were collected for the sector. The production parameters and financial effects of the interventions were then described to illustrate impact on the supply chain. The effects of the interventions were also assessed at market level using economic welfare analysis. The sectors in Finland and the UK are small in farm numbers and few companies produced much of the output in a largely vertically-integrated structure. The most beneficial intervention in financial terms to farmers was improved hygiene in pig fattening (around +50% in gross margin). It was calculated to reduce the consumer price for pig meat by up to 5% when applied at large, whereas for improved management measures, it would reduce consumer price by less than 0.5%. However, the latter added value also through food quality attributes. We show that good hygiene and animal care can add value. However, evaluation of the financial and social viability of the interventions is needed to decide what interventions are adopted. The structure of supply chains influences which policy measures could be applied. Of the two interventions, improved pig hygiene had the largest potential to improve efficiency and reduce costs. The studied interventions can also provide new business opportunities to farms, slaughterhouses and food sector companies. More evidence is needed to support public policies and business decision-making in the sector. For this, evidence on consumer attitudes to production diseases is needed. Nevertheless, the study makes an important contribution by showing how improvements in health and welfare benefit the whole chain

Kent and Medway acute mental health services review

An independent analysis of the public response to a consultation on ‘achieving excellent care in a mental health crisis’ by the Centre for Nursing and Healthcare Research at the University of Greenwich. Background: This document presents the results of an analysis of the responses to the formal public consultation on Acute Mental Health Crisis Care services which took place over a 13 week period from 26 July 2012 to 26 October 2012. The consultation was conducted by NHS Kent and Medway working in partnership with Kent and Medway NHS and Social Care Partnership Trust, and the data gathered was analysed independently by the Centre for Nursing and Healthcare Research at the University of Greenwich

Rhode Island Quality Institute: A Statewide Partnership to Improve Health Care Quality

Describes the first state-initiated public-private partnership for quality improvement and the establishment of an independent nonprofit organization to coordinate efforts. Examines elements of success, including leadership structure, and lessons learned

A Review of Best Practices for Monitoring and Improving Inpatient Pediatric Patient Experiences.

ContextAchieving high-quality patient-centered care requires assessing patient and family experiences to identify opportunities for improvement. With the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey, hospitals can assess performance and make national comparisons of inpatient pediatric experiences. However, using patient and family experience data to improve care remains a challenge.ObjectiveWe reviewed the literature on best practices for monitoring performance and undertaking activities aimed at improving pediatric patient and family experiences of inpatient care.Data sourcesWe searched PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsychINFO.Study selectionWe included (1) English-language peer-reviewed articles published from January 2000 to April 2019; (2) articles based in the United States, United Kingdom, or Canada; (3) articles focused on pediatric inpatient care; (4) articles describing pediatric patient and family experiences; and (5) articles including content on activities aimed at improving patient and family experiences. Our review included 25 articles.Data extractionTwo researchers reviewed the full article and abstracted specific information: country, study aims, setting, design, methods, results, Quality Improvement (QI) initiatives performed, internal reporting description, best practices, lessons learned, barriers, facilitators and study implications for clinical practice, patient-experience data collection, and QI activities. We noted themes across samples and care settings.ResultsWe identified 10 themes of best practice. The 4 most common were (1) use evidence-based approaches, (2) maintain an internal system that communicates information and performance on patient and family experiences to staff and hospital leadership, (3) use experience survey data to initiate and/or evaluate QI interventions, and (4) identify optimal times (eg, discharge) and modes (eg, print) for obtaining patient and family feedback. These correspond to adult inpatient best practices.ConclusionsBoth pediatric and adult inpatient best practices rely on common principles of culture change (such as evidence-based clinical practice), collaborative learning, multidisciplinary teamwork, and building and/or supporting a QI infrastructure that requires time, money, collaboration, data tracking, and monitoring. QI best practices in both pediatric and adult inpatient settings commonly rely on identifying drivers of overall ratings of care, rewarding staff for successful implementation, and creating easy-to-use and easy-to-access planning and QI tools for staff

Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations

Study protocol for the Anesthesiology Control Tower—Feedback Alerts to Supplement Treatments (ACTFAST-3) trial: A pilot randomized controlled trial in intraoperative telemedicine [version 1; referees: 2 approved]

Background: Each year, over 300 million people undergo surgical procedures worldwide. Despite efforts to improve outcomes, postoperative morbidity and mortality are common. Many patients experience complications as a result of either medical error or failure to adhere to established clinical practice guidelines. This protocol describes a clinical trial comparing a telemedicine-based decision support system, the Anesthesiology Control Tower (ACT), with enhanced standard intraoperative care. Methods: This study is a pragmatic, comparative effectiveness trial that will randomize approximately 12,000 adult surgical patients on an operating room (OR) level to a control or to an intervention group. All OR clinicians will have access to decision support software within the OR as a part of enhanced standard intraoperative care. The ACT will monitor patients in both groups and will provide additional support to the clinicians assigned to intervention ORs. Primary outcomes include blood glucose management and temperature management. Secondary outcomes will include surrogate, clinical, and economic outcomes, such as incidence of intraoperative hypotension, postoperative respiratory compromise, acute kidney injury, delirium, and volatile anesthetic utilization. Ethics and dissemination: The ACTFAST-3 study has been approved by the Human Resource Protection Office (HRPO) at Washington University in St. Louis and is registered at clinicaltrials.gov (NCT02830126). Recruitment for this protocol began in April 2017 and will end in December 2018. Dissemination of the findings of this study will occur via presentations at academic conferences, journal publications, and educational materials