Electronic Dashboard Research Articles

DASHBOARDS FOR INPUT-EVALUATION OF POLICY PROGRAMS: LESSONS LEARNED FROM AN ANTWERP DASHBOARD FOR GARDEN STREETS

Abstract. There is an ever-growing trend to pursue policies based on evidence-based and data-driven program evaluation research. In order to facilitate such evaluation research, electronic dashboards are increasingly used for translating sources of big and unstructured data into low-level summary visualizations understandable by layman policy-makers. In this paper, we report on the dashboard development process for an input-evaluation of new garden streets in the city of Antwerp. During this process, different lessons were learned. First, developers should start from a clearly defined policy question and analysis units in order to optimize the development process. Second, different types of key performance indicators exist, which should also be well-defined in advance so that appropriate data can be collected. Third, a dashboard should not be restricted to purely objective data-analyses but may also include features that facilitate subjective evaluation guided by assumptions and believes of the dashboard-user. These lessons helped us to make the dashboard requirements of Antwerp more concrete. Likewise, they may help other policy supporting dashboard developers to optimize their development processes.

University of California, San Francisco School of Medicine

University of California, San Francisco School of Medicine

University of Michigan Medical School.

University of Michigan Medical School.

Western University Schulich School of Medicine & Dentistry.

Western University Schulich School of Medicine & Dentistry.

Women Are Less Likely to Be Tested for HIV or Offered Preexposure Prophylaxis at the Time of Sexually Transmitted Infection Diagnosis.

Ending the HIV epidemic requires linkage of at-risk individuals from diverse health care settings to comprehensive HIV prevention services. Sexually transmitted infections (STIs) are significant biomarkers of HIV risk and should trigger preexposure prophylaxis (PrEP) discussion. We reviewed STI testing practices outside of sexual health clinics to identify opportunities for improvement in the provision of HIV prevention services. An electronic sexual health dashboard was used to identify patient encounters with a positive gonorrhea, chlamydia, and/or rapid plasma reagin test result between January 1, 2019, and August 23, 2019, at a large urban academic medical center. A retrospective chart review was performed to assess HIV testing, completeness of STI screening, and HIV prevention discussion; inadequate screening was defined as no HIV test in 12 months before STI diagnosis. A total of 815 patients with 856 patient encounters were included. Patients were predominantly female (64.4%); median age was 24 years (range, 18-85 years). The most common test and most common positive test result was the genitourinary gonorrhea/chlamydia nucleic acid amplification test. Multisite testing was rare (7.5% of patient encounters) and performed more frequently in men than in women (20.3% vs. 0.36%). Women were also more likely to be inadequately screened for HIV (15.1% vs. 25.8%).Documentation of PrEP discussion was rare (4.7% of patient encounters) compared with safe sex (44.6%) and condoms (49.8%). Preexposure prophylaxis was discussed almost exclusively with men compared with women (17% vs. 1.1%). In patients diagnosed with bacterial STI outside of sexual health clinics, gaps in HIV prevention exist. HIV screening, multisite STI screening, and discussion of PrEP were particularly infrequent among women.

Development of an Electronic Dashboard to Monitor Intra-operative Patient Core Temperatures

<h3>Background</h3> Maintaining normothermia is a complex process which requires collaboration from perioperative personnel throughout all phases of perioperative care. It's essential that a patient's core temperature remain within normothermic range (36°C-38°C) to mitigate risk for surgical site infections (SSI) as well as other complications. Our surgical site infection performance improvement team (SSI-PI) implemented several interventions to maintain normothermia for our surgical patients but lacked an efficient process to obtain intra-operative core temperatures from the medical record to measure the efficacy of these interventions. This need led to development of an electronic dashboard to streamline review of intra-operative core temperatures. <h3>Methods</h3> At a 1,541 bed academic medical center, an Infection Preventionist along with SSI-PI team members collaborated with our Joint Data Analytics Team to create an electronic dashboard which communicates with our electronic medical record system to collate intra-operative core temperatures that are recorded every minute. Colorectal, abdominal hysterectomy and total joint arthroplasty procedures were chosen as the primary focus to develop this interactive dashboard. The dashboards contents and format were selected based on feedback provided by SSI-PI team members. Data within the dashboard was validated for accuracy by an Infection Preventionist. <h3>Results</h3> The dashboard shows starting, final, mean, and median core temperature measurements and calculates the percentage of core temperatures below 36.0°C for each patient. All temperature metrics can be displayed as an aggregate as well. Data can be analyzed by date range and filtered by hospital within our healthcare system, procedure type, surgeon, anesthesiologist, warming method, and by infection status. <h3>Conclusions</h3> Overall, this electronic dashboard has helped our SSI-PI team better understand the core temperature distribution among patients during their surgical procedures. More importantly, it has allowed the SSI-PI team to measure the effectiveness of warming practices in order to better maintain patient normothermia throughout the perioperative period.

Expansion and Evaluation of Pharmacist Services in Primary Care.

Challenges with primary care access and overextended providers present opportunities for pharmacists as patient care extenders for chronic disease management. The primary objective was to align primary care pharmacist services with organizational priorities and improve patient clinical outcomes. The secondary objective was to develop a technological strategy for service evaluation. An interdisciplinary workgroup developed primary care pharmacist services focused on improving performance measures and supporting the care team in alignment with ongoing population health initiatives. Pharmacist collaborative practice agreements (CPAs) were developed and implemented. An electronic dashboard was developed to capture service outcome measures. Blood pressure control to <140/90 mmHg was achieved in 74.15% of patients who engaged with primary care pharmacists versus 41.53% of eligible patients electing to follow usual care pathways. Appropriate statin use was higher in patients engaged with primary care pharmacists than in eligible patients electing to follow usual care pathways both for diabetes and ischemic vascular disease (12.4% and 2.2% higher, respectively). Seventeen of 54 possible process and outcome measures were identified and incorporated into an electronic dashboard. Primary care pharmacist services improve hypertension control and statin use. Service outcomes can be measured with discrete data from the electronic health record (EHR), and should align with organizational priorities.

COVID-19 and Long-term Planning for Procedure-based Specialties During Extended Mitigation and Suppression Strategies

COVID-19 and Long-term Planning for Procedure-based Specialties During Extended Mitigation and Suppression Strategies

Involving patients as key stakeholders in the design of cardiovascular implantable electronic device data dashboards: Implications for patient care.

BackgroundData from remote monitoring (RM) of cardiovascular implantable electronic devices (CIEDs) currently are not accessible to patients despite demand. The typical RM report contains multiple pages of data for trained technicians to read and interpret and requires a patient-centered approach to be curated to meet individual user needs.ObjectiveThe purpose of this study was to understand which RM data elements are important to patients and to gain design insights for displaying meaningful data in a digital dashboard.MethodsAdults with implantable cardioverter–defibrillators (ICDs) and pacemakers (PMs) participated in this 2-phase, user-centered design study. Phase 1 included a card-sorting activity to prioritize device data elements. Phase 2 included one-on-one design sessions to gather insights and feedback about a visual display (labels and icons).ResultsTwenty-nine adults (mean age 71.8 ± 11.6 years; 51.7% female; 89.7% white) participated. Priority data elements for both ICD and PM groups in phase 1 (n = 19) were related to cardiac episodes, device activity, and impedance values. Recommended replacement time for battery was high priority for the PM group but not the ICD group. Phase 2 (n = 10) revealed that patients would like descriptive, nontechnical terms to depict the data and icons that are intuitive and informative.ConclusionThis user-centered design study demonstrated that patients with ICDs and PMs were able to prioritize specific data from a comprehensive list of data elements that they had never seen before. This work contributes to the goal of sharing RM data with patients in a way that optimizes the RM feature of CIEDs for improving patient outcomes and clinical care.

Understanding the utilisation of a novel interactive electronic medication safety dashboard in general practice: a mixed methods study

BackgroundImproving medication safety is a major concern in primary care settings worldwide. The Salford Medication safety dASHboard (SMASH) intervention provided general practices in Salford (Greater Manchester, UK) with feedback on their safe prescribing and monitoring of medications through an online dashboard, and input from practice-based trained clinical pharmacists. In this study we explored how staff working in general practices used the SMASH dashboard to improve medication safety, through interactions with the dashboard to identify potential medication safety hazards and their workflow to resolve identified hazards.MethodsWe used a mixed-methods study design involving quantitative data from dashboard user interaction logs from 43 general practices during the first year of receiving the SMASH intervention, and qualitative data from semi-structured interviews with 22 pharmacists and physicians from 18 practices in Salford.ResultsPractices interacted with the dashboard a median of 12.0 (interquartile range, 5.0–15.2) times per month during the first quarter of use to identify and resolve potential medication safety hazards, typically starting with the most prevalent hazards or those they perceived to be most serious. Having observed a potential hazard, pharmacists and practice staff worked together to resolve that in a sequence of steps (1) verifying the dashboard information, (2) reviewing the patient’s clinical records, and (3) deciding potential changes to the patient’s medicines. Over time, dashboard use transitioned towards regular but less frequent (median of 5.5 [3.5–7.9] times per month) checks to identify and resolve new cases. The frequency of dashboard use was higher in practices with a larger number of at-risk patients. In 24 (56%) practices only pharmacists used the dashboard; in 12 (28%) use by other practice staff increased as pharmacist use declined after the initial intervention period; and in 7 (16%) there was mixed use by both pharmacists and practice staff over time.ConclusionsAn online medication safety dashboard enabled pharmacists to identify patients at risk of potentially hazardous prescribing. They subsequently worked with GPs to resolve risks on a case-by-case basis, but there were marked variations in processes between some practices. Workload diminished over time as it shifted towards resolving new cases of hazardous prescribing.

Development, implementation and user experience of the Veterans Health Administration (VHA) dialysis dashboard

BackgroundAdults with end-stage renal disease (ESRD) requiring chronic dialysis continue to suffer from poor health outcomes and represent a population rightfully targeted for quality improvement. Electronic dashboards are increasingly used in healthcare to facilitate quality measurement and improvement. However, detailed descriptions of the creation of healthcare dashboards are uncommonly available and formal inquiry into perceptions, satisfaction, and utility by clinical users has been rarely conducted, particularly in the context of dialysis care. Therefore, we characterized the development, implementation and user experience with Veterans Health Administration (VHA) dialysis dashboard.MethodsA clinical-quality dialysis dashboard was implemented, which displays clinical performance measures (CPMs) for Veterans with ESRD receiving chronic hemodialysis at all VHA facilities. Data on user experience and perceptions were collected via an e-mail questionnaire to dialysis medical directors and nurse managers at these facilities.ResultsSince 2016 the dialysis dashboard reports monthly on CPMs for approximately 3000 Veterans receiving chronic hemodialysis across 70 VHA dialysis facilities. Of 141 dialysis medical directors and nurse managers, 61 completed the questionnaire. Sixty-six percent of respondents did not find the dashboard difficult to access, 64% agreed that it is easy to use, 59% agreed that its layout is good, and the majority agreed that presentation of data is clear (54%), accurate (56%), and up-to-date (54%). Forty-eight percent of respondents indicated that it helped them improve patient care while 12% did not. Respondents indicated that they used the dialysis dashboard for clinical reporting (71%), quality assessment/performance improvement (QAPI) (62%), and decision-making (23%).ConclusionsMost users of the VHA dialysis dashboard found it accurate, up-to-date, easy to use, and helpful in improving patient care. It meets diverse user needs, including administrative reporting, clinical benchmarking and decision-making, and quality assurance and performance improvement (QAPI) activities. Moreover, the VHA dialysis dashboard affords national-, regional- and facility-level assessments of quality of care, guides and motivates best clinical practices, targets QAPI efforts, and informs and promotes population health management improvement efforts for Veterans receiving chronic hemodialysis.

Academic detailing in oral healthcare – results of the ADVOCATE Field Studies

Background: Academic detailing (AD) is a defined form of educational outreach that can be used to influence decision making and reduce unwarranted variation in healthcare delivery. This paper describes the results of the proof of concept phase of the ADVOCATE Field Studies. This study evaluated the feasibility, acceptability and usefulness of AD reinforced with feedback data, to promote prevention-oriented, patient-centred and evidence-based oral healthcare delivery by general dental practitioners (GDPs).Methods: In the Field Studies, six groups of GDPs (n = 39) were recruited in The Netherlands, Germany and Denmark. Each group had four meetings reinforced with feedback data for open discussions on dental practice and healthcare delivery. Conventional and directed content analysis was used to analyze the qualitative data collected from focus group interviews, debriefing interviews, field notes and evaluation forms.Results: A total of nine themes were identified. Seven themes related to the process of the Field Studies and covered experiences, barriers and facilitators to AD group meetings, data collection and the use of an electronic dashboard for data presentation and storage. Two themes related to the outcomes of the study, describing how GDPs perceived they made changes to their clinical practice as a result of the Field Studies.Conclusions: The ADVOCATE Field Studies approach offers a novel way of collecting and providing feedback to care providers which has the potential to reduce variation oral healthcare delivery. AD plus feedback data is a useful, feasible approach which creates awareness and gives insight into care delivery processes. Some logistic and technical barriers to adoption were identified, which if resolved would further improve the approach and likely increase the acceptability amongst GDPs.

Implementation of an Electronic Dashboard with A Remote Management System to Improve Glycemic Management Among Hospitalized Adults

Objective: Better glycemic control for hospitalized diabetic patients significantly reduces health expenditures and improves disease outcomes. We developed a dynamic dashboard with a remote management system and evaluated its impact on inpatient glycemic control. Methods: This was an observational institution-wide study; study participants were enrolled from a 1,500-bed public medical center from 2016 to 2018. We evaluated the impact of a dynamic dashboard system, which analyzed and monitored all glucose data with virtual glycemic management recommendation by a team of endocrinologists, over 3 × 1-year periods: 2016 (pre-implementation), 2017 (development), and 2018 (implementation). Results: A total of 51,641 discharges with 878,159 blood glucose measurements were obtained during the 3-year period. After implementation of the dashboard system, the proportion of patients with poor glycemic control (hyperglycemia or hypoglycemia) was reduced by 31% (from 10.2 to 7.0 per day per 100 patients with glucose monitoring; P<.001); hyperglycemia decreased by 25% (from 6.1 to 4.6 per day per 100 patients with glucose monitoring; P<.001), and hypoglycemia decreased by 45% (from 4.2 to 2.3 per day per 100 patients with glucose monitoring; P<.001). Furthermore, the trend in the proportion of patients within the treat-to-target range showed significant improvement (P<.001) during the development period, with effectiveness maintained throughout the implementation period. Conclusion: We successfully installed a dynamic, electronic medical records-based dashboard monitoring system to improve inpatient glycemic control. The system, supported by a team of endocrinologists via remote recommendations, could efficiently fill an important need for improved glycemic management among hospitalized adults. Abbreviations: CDE = certified diabetes educator; DM = diabetes mellitus; EMR = electronic medical record; POC = point-of-care; TCVGH = Taichung Veterans General Hospital; UCSF = University of California, San Francisco; U.S. = United States; vGMS = virtual glucose management service.

Abstract WP456: Using An Electronic Dashboard To Improve Communication On Stroke Core Measure Compliance

Background and Purpose: Several years ago, an excel spreadsheet was created to improve real time communication about stroke core measure compliance to all the inpatient units. This daily spreadsheet was sent to the nursing leadership to be shared with the nurse or MD to ensure the stroke orders were carried out and patient education provided. The process to review each chart daily for compliance with the core measures, enter it into the spreadsheet, send it to the nursing leadership daily took approximately 3 hours or more a day. This was not an efficient use of time. We decided to create an electronic dashboard that would extract all of the stroke core measure information from the electronic patient record automatically, eliminating manual abstraction, thus making the process more efficient while allowing effective communication throughout the organization. Methods: Our IT department, working alongside our Stroke Care Team, developed data extraction processes pertinent to Stroke Core Measures to allow for an hourly extraction into a Tableau dashboard. This software allows for logic to be applied to the various elements to evaluate the successful completion of each core measure for patients currently admitted to our institution for Stroke-related diagnoses and conditions. Results: The key stake holders for each unit review the dashboard which is refreshed hourly to identify areas that have not met the measure. After the review, the leadership implements a plan to improve attainment for these measures. The dashboard has also allowed for correction of documentation in real time but has limitations because it depends on the data within the electronic medical record and the programing to extract that data. The team communicates with our IT department to correct the issues with the data displayed in tableau. Conclusions: The tableau dashboard is an effective and efficient tool providing a snapshot of the current attainment of the primary and comprehensive stroke core measures. The implementation of this dashboard has increased awareness of the stroke core measure compliance and has improved communication among the clinical staff.

What Do We Do After the Pilot Is Done? Implementation of a Hospital Early Warning System at Scale

Adults who deteriorate outside the ICU have high mortality. Most rapid response systems (RRSs) have employed manual detection processes that rapid response teams (RRTs) use to identify patients at risk. This project piloted the use of an automated early warning system (EWS), based on a very large database, that provides RRTs with 12 hours lead time to mount a response. Results from a 2-hospital pilot were encouraging, so leadership decided to deploy the Advance Alert Monitor (AAM) program in 19 more hospitals. How can one deploy an RRS using an automated EWS at scale? EWS displays were removed from frontline clinicians' hospital electronic dashboards, and a Virtual Quality Team (VQT) RN was interposed between the EWS and the RRT. VQT RNs monitor the EWS remotely-when alerts are issued, they conduct a preliminary chart review and contact hospital RRT RNs. VQT and RRT RNs review the cases jointly. The RRT RNs then consult with hospitalists regarding clinical rescue and/or palliative care workflows. Subsequently, VQT RNs monitor patient charts, ensuring adherence to RRS practice standards. To enable this process, the project team developed a governance structure, clinical workflows, palliative care workflows, and documentation standards. The AAM Program now functions in 21 Kaiser Permanente Northern California hospitals. VQT RNs monitor EWS alerts 24 hours a day, 7 days a week. The AAM Program handles ∼16,000 alerts per year. Its implementation has resulted in standardization of RRT staffing, clinical rescue workflows, and in-hospital palliative care.

Evaluation of a Health Information Technology-Enabled Panel Management Platform to Improve Anticoagulation Control in a Low-Income Patient Population: Protocol for a Quasi-Experimental Design.

BackgroundWarfarin is one of the most commonly prescribed medications in the United States, and it causes a significant proportion of adverse drug events. Patients taking warfarin fall outside of the recommended therapeutic range 30% of the time, largely because of inadequate laboratory monitoring and dose adjustment. This leads to an increased risk of blood clots or bleeding events. We propose a comparative effectiveness study to examine whether a technology-enabled anticoagulation management program can improve long-term clinical outcomes compared with usual care.ObjectiveOur proposed intervention is the implementation of an electronic dashboard (integrated into a preexisting electronic health record) and standardized workflow to track patients’ laboratory results, identify patients requiring follow-up, and facilitate the use of a validated nomogram for dose adjustment. The primary outcome of this study is the time in therapeutic range (TTR) at 6 months post intervention (a validated metric of anticoagulation quality among patients receiving warfarin).MethodsWe will employ a pre-post quasi-experimental design with a nonequivalent usual-care comparison site and a difference-in-differences approach to compare the effectiveness of a technology-enabled anticoagulation management program compared with usual care at a large university-affiliated safety-net clinic.ResultsWe used a commercially available health information technology (HIT) platform to host a registry of patients on warfarin therapy and create the electronic dashboard for panel management. We developed the intervention with, and for, frontline clinician users, using principles of human-centered design. This study is funded until September 2020 and is approved by the University of California, San Francisco Institutional Review Board until June 22, 2020. We completed data collection in September 2019 and expect to complete our proposed analyses by February 2020.ConclusionsWe anticipate that the intervention will increase TTR among patients taking warfarin and that the use of this HIT platform will facilitate tracking and monitoring of patients on warfarin, which could enable outreach to those overdue for visits or laboratory monitoring. We will use these findings to iteratively improve the platform in preparation for a larger, multiple-site, pragmatic clinical trial. If successful, our study will demonstrate the integration of HIT platforms into existing electronic health records to improve patient care in real-world clinical settings.International Registered Report Identifier (IRRID)DERR1-10.2196/13835

Emergency room visualization dashboard user satisfaction in Saudi Arabia

Abstract Visualization dashboards are used in the emergency room (ER) to provide employees with continuous access to vital patient information. Royal Commission Hospital in Jubail decided to implement an electronic dashboard in the ER, to improve the visibility of patient data. An electronic survey was administered to measure the end-user satisfaction with the dashboard among all physicians, nurses, and receptionists working in the ER, for which 51 responses were received. Generally, the staff was satisfied with the use of electronic dashboards in the ER. User satisfaction was positively correlated with the perceived impact of the dashboard's use on the efficiency of work and the quality of care. This study shows positive end-user interaction and satisfaction with electronic ER dashboards, which future studies can link to improved patient care.

Use of a Electronic Sickle Cell Dashboard to Improve Annual Transcranial Doppler Ultrasound (TCD) Completion Rates

Background: Stroke, a feared and common complication of sickle cell anemia can be prevented by early recognition of at-risk individuals using annual screening transcranial Doppler ultrasound (TCD) and subsequent treatment with chronic transfusion therapy. The landmark STOP trial established annual screening TCD from 2 to 16 years of age as a standard of care for children with sickle cell anemia. Compliance with this recommendation remains challenging in a majority of sickle cell centers due to various reasons. Methods: An analysis of the institutional process of obtaining TCD revealed several opportunities for improvement. Provider attention was diverted from TCD screening towards management of acute complications such as fever and pain, hydroxyurea management, vaccine administration and psychosocial issues. Other factors contributing to poor TCD completion rates included high no-show rates for annual comprehensive visits, routine preventive visits, and hospital follow-ups. In addition, there were barriers to scheduling and completion of TCD studies after order placement. We hypothesized that by utilizing information technology (IT) tools we could improve TCD ordering and completion rates. Our IT team, in collaboration with our hematology team, designed and optimized the electronic clinic note specific to sickle cell disease in order to capture data such as age, sickle cell phenotype, eligibility for TCD, and last completed TCD date. Utilizing these data an innovative, real-time, sickle-cell dashboard was created and made available to all clinicians. In a single screen view, the dashboard displayed data regarding TCD eligible patients that needed an order for TCD, had a TCD scheduled, or were over-due or near-due for TCD. Amongst these, those who had upcoming appointments were especially highlighted in order to coordinate their clinic and TCD visits on the same day. The dashboard also highlighted patients who were overdue for TCD with no scheduled clinic appointments This data was reviewed by sickle cell nurse coordinator, a physician champion and an IT representative at least weekly. Inaccuracies in data were identified and corrected. The action items were then presented at the weekly sickle cell team meeting and acted upon. We then measured TCD order and completion rates before and after the January 2019 implementation of the dashboard. Results: In 2018 thirty-six orders for TCD were placed with eighteen completed studies (50%) versus 47 orders placed with 42 completed TCD in the first 7 months of 2019 (89%). These results were clinically significant (p=0.0001, Two-sided Fisher's exact test). As of July 31, 2019 out of 68 eligible patients, all but 2 had TCD orders placed (97%). Fifty-one patients were current on their TCD (75%) and the majority of those patients with missing TCD were noncompliant with clinic and radiology appointments. For the first 6 months of the year, an average of 93% of patients were compliant with annual TCD at the time of their clinic visit Conclusion: An IT dashboard created using real-time data; collaboration and communication between clinical, IT and radiology teams; and action during regularly scheduled sickle cell team meetings resulted in marked improvement in TCD ordering and completion rates within a few months. The process was sustainable by training nursing and ancillary staff to utilize data. In the future, this sickle cell dashboard could be utilized to also improve other areas of sickle cell care such as immunizations and medication compliance. Disclosures Gomez: Alnylam: Consultancy; Novo Nordisk, Novartis, Pfizer, Sanofi, Takeda, UniQure: Research Funding.

GERIATRICS MICU CO-MANAGEMENT: INTEGRATING GERIATRIC ASSESSMENTS FOR CRITICALLY ILL PATIENTS

Programs like orthogeriatrics, geriatric cardiology have shown to improve outcomes in hospitalized geriatric patients. Our Geriatrics MICU Co-management program is a quality improvement initiative that instigates a partnership approach with critical care medicine in integrating geriatric assessments and build foundation for interdisciplinary care of critically ill patients. MICU (Medical Intensive Care Unit) protocols do not have standard geriatrics assessments integrated in clinical care. An electronic dash-board identifies high risk elderly (HRE) patients admitted at a MICU in a large teaching hospital in Northeast Ohio based on nursing specific screening triggers. A geriatrics co-management team engages in a comprehensive geriatric assessments and care transition. 386 patient were identified using HRE screening triggers in a period of 100 days. 33 % (n=131) were generated as consults for co-management. A pilot review on 131 HRE patients was conducted. 70% (n=93) patients had incident frailty. 93% (n=87) of patients with frailty were diagnosed with incident delirium. 56% (n=74) of patients were newly diagnosed with cognitive impairment. 56 % (N=74) of patients had a medication reduction. An average of 1.23 medication was changed. 85% (n =112) of patients had a warm hand off to the next level of provider on discharge. 90% (n=119) of patients notified improved self-management skills and better understanding of discharge process. The Geri-MICU program demonstrates a patient -centered approach in integrating geriatric assessments for critically ill patients and build foundation of a geriatrics-critical care task force. The program would be a mile stone in optimizing elderly care in critical care units.

Clinical Impact of an Electronic Dashboard and Alert System for Sedation Minimization and Ventilator Liberation: A Before-After Study.

Multi-ICU proof-of-concept study and a single ICU before-after study. University hospital ICUs. Adult patients receiving mechanical ventilation. An automated application consisting of 1) a web-based dashboard with real-time data on spontaneous breathing trial readiness, sedation depth, sedative infusions, and nudges to wean sedation and ventilatory support and 2) text-message alerts once patients met criteria for a spontaneous breathing trial and spontaneous awakening trial. Pre-intervention, sedation minimization, and ventilator liberation were reviewed daily during a multidisciplinary huddle. Post-intervention, the dashboard was used during the multidisciplinary huddle, throughout the day by respiratory therapists, and text alerts were sent to bedside providers. We enrolled 115 subjects in the proof-of-concept study. Spontaneous breathing trial alerts were accurate (98.3%), usually sent while patients were receiving mandatory ventilation (88.5%), and 61.9% of patients received concurrent spontaneous awakening trial alerts. We enrolled 457 subjects in the before-after study, 221 pre-intervention and 236 post-intervention. After implementation, patients were 28% more likely to be extubated (hazard ratio, 1.28; 95% CI, 1.01-1.63; p = 0.042) and 31% more likely to be discharged from the ICU (hazard ratio, 1.31; 95% CI, 1.03-1.67; p = 0.027) at any time point. After implementation, the median duration of mechanical ventilation was 2.20 days (95% CI, 0.09-4.31 d; p = 0.042) shorter and the median ICU length of stay was 2.65 days (95% CI, 0.13-5.16 d; p = 0.040) shorter, compared with the expected durations without the application. Implementation of an electronic dashboard and alert system promoting sedation minimization and ventilator liberation was associated with reductions in the duration of mechanical ventilation and ICU length of stay.