Elektronische beslissingsondersteuning in de zorg:Enorme potentie, complexe implementatie

Zorgprofessionals nemen dagelijks veel beslissingen ten aanzien van de zorg voor hun patiënten. Deze dagelijkse medische besluitvorming wordt steeds moeilijker door de intrinsieke complexiteit en interacties van de aandoeningen binnen een ouder wordende bevolking. Daarnaast wordt de besluitvorming beïnvloed door andere factoren op de werkvloer, zoals wisseling in personeel, de variatie aan kennis en ervaring binnen het personeel, de hoge intensiteit van het werk en alle administratieve taken. Als laatste blijven medische data en kennis toenemen waardoor het verkrijgen van een overzicht van het patiëntdossier lastig is. Elektronische klinische beslissingsondersteunende systemen kunnen zorgprofessionals ondersteunen bij het verkrijgen van dit overzicht en de dagelijkse besluitvorming, maar de invoering van deze systemen blijft achter. In dit artikel wordt ingegaan op de uitdagingen en belemmeringen die rondom de ontwikkeling en invoering van klinische beslissingsondersteunende systemen bestaan

Continue monitoring van vitale parameters op de verpleegafdeling:Afwachten of instappen?

Verschillende slimme pleisters en draagbare monitoren kunnen op een niet-invasieve wijze vitale parameters meten. Continue registratie door deze wearables maakt trendvisualisatie en -analyse mogelijk om zorgprofessionals op tijd te alarmeren voor klinische achteruitgang. Het doel is niet alleen complicaties op te sporen en sterfgevallen te verminderen, maar ook om verpleegkundige werkdruk te verlichten. Ondanks de snelle evolutie van deze sensoren is de belangrijkste vraag nu: hoe valide, effectief en lokaal bruikbaar zijn deze wearables? En is eventuele aanschaf al te rechtvaardigen? Eenduidige richtlijnen over de vereisten van deze sensoren ontbreken en wetenschappelijk bewijs over de validiteit en klinische effectiviteit is nog beperkt. Recent medisch onderzoek laat echter voor het eerst zien dat de vitale parameters van deze wearables in combinatie met slimme algoritmes de ziekenhuismortaliteit en morbiditeit kunnen verminderen

Quality Improvement in the Preoperative Evaluation:Accuracy of an Automated Clinical Decision Support System to Calculate CHA2DS2-VASc Scores

Background and Objectives: Clinical decision support systems are advocated to improve the quality and efficiency in healthcare. However, before implementation, validation of these systems needs to be performed. In this evaluation we tested our hypothesis that a computerized clinical decision support system can calculate the CHA2DS2-VASc score just as well compared to manual calculation, or even better and more efficiently than manual calculation in patients with atrial rhythm disturbances. Materials and Methods: In n = 224 patents, we calculated the total CHA2DS2-VASc score manually and by an automated clinical decision support system. We compared the automated clinical decision support system with manually calculation by physicians. Results: The interclass correlation between the automated clinical decision support system and manual calculation showed was 0.859 (0.611 and 0.931 95%-CI). Bland-Altman plot and linear regression analysis shows us a bias of −0.79 with limit of agreement (95%-CI) between 1.37 and −2.95 of the mean between our 2 measurements. The Cohen’s kappa was 0.42. Retrospective analysis showed more human errors than algorithmic errors. Time it took to calculate the CHA2DS2-VASc score was 11 s per patient in the automated clinical decision support system compared to 48 s per patient with the physician. Conclusions: Our automated clinical decision support system is at least as good as manual calculation, may be more accurate and is more time efficient

The impact of high versus standard enteral protein provision on functional recovery following intensive care admission (PRECISE trial): study protocol for a randomized controlled, quadruple blinded, multicenter, parallel group trial in mechanically ventilated patients

Abstract Background Critically ill patients are subject to severe skeletal muscle wasting during intensive care unit (ICU) stay, resulting in impaired short- and long-term functional outcomes and health-related quality of life. Increased protein provision may improve functional outcomes in ICU patients by attenuating skeletal muscle breakdown. Supporting evidence is limited however and results in great variety in recommended protein targets. Methods The PRECISe trial is an investigator-initiated, bi-national, multi-center, quadruple-blinded randomized controlled trial with a parallel group design. In 935 patients, we will compare provision of isocaloric enteral nutrition with either a standard or high protein content, providing 1.3 or 2.0 g of protein/kg/day, respectively, when fed on target. All unplanned ICU admissions with initiation of invasive mechanical ventilation within 24 h of admission and an expected stay on ventilator support of at least 3 days are eligible. The study is designed to assess the effect of the intervention on functional recovery at 1, 3, and 6 months following ICU admission, including health-related quality of life, measures of muscle strength, physical function, and mental health. The primary endpoint of the trial is health-related quality of life as measured by the Euro-QoL-5D-5-level questionnaire Health Utility Score. Overall between-group differences will be assessed over the three time points using linear mixed-effects models. Discussion The PRECISe trial will evaluate the effect of protein on functional recovery including both patient-centered and muscle-related outcomes. Trial registration ClinicalTrials.gov Identifier: NCT04633421 . Registered on November 18, 2020. First patient in (FPI) on November 19, 2020. Expected last patient last visit (LPLV) in October 2023