Towards a Flexible Assessment of Compliance with Clinical Protocols Using Fuzzy Aggregation Techniques

In healthcare settings, compliance with clinical protocols and medical guidelines is important to ensure high-quality, safe and effective treatment of patients. How to measure compliance and how to represent compliance information in an interpretable and actionable way is still an open challenge. In this paper, we propose new metrics for compliance assessments. For this purpose, we use two fuzzy aggregation techniques, namely the OWA operator and the Sugeno integral. The proposed measures take into consideration three factors: (i) the degree of compliance with a single activity, (ii) the degree of compliance of a patient, and (iii) the importance of the activities. The proposed measures are applied to two clinical protocols used in practice. We demonstrate that the proposed measures for compliance can further aid clinicians in assessing the aspect of protocol compliance when evaluating the effectiveness of implemented clinical protocols. Keywords: clinical protocols; protocol compliance; protocol adherence; protocol conformance; aggregation; OWA operator; Sugeno integra

On accurate, automated and insightful deviation analysis of clinical protocols

Clinical guidelines, pathways and protocols are introduced to standardize and provide best-practice care. Analyzing deviations of actual care against the documented best practices is useful to find opportunities for complying better in the future. Prior work demonstrates that deviation analyses should be accurate, automated and insightful but only few studies manage to satisfy all three intentions. In this paper, we manage to reconcile accuracy with automation and insightfulness by combining the previously disconnected steps of checking and mining in compliance analysis software. Results are achieved using an algorithm that consists of three steps. We demonstrate the effectiveness of the algorithm via a real-life case from the intensive care unit of a Dutch hospital

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

International audienceBackground: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society