Everyday Clinical Care Research Articles

Multiple Pediatric Extracorporeal Membrane Oxygenation Runs and Futility. What Are the Limits?

Despite high mortality rates, pediatric extracorporeal membrane oxygenation (ECMO) redeployments are frequently discussed in everyday clinical care. We aim to investigate predictors of mortality in those patients. Clinical data from a single pediatric center were retrospectively analyzed. Patients with multiple ECMO runs between 2010 and 2023 were included. A total of 70 (13%) patients required multiple ECMO runs. Of those, 56 (80%) died before discharge; late mortality was 89% at a median of 1.6 (1.0-3.9) years. A total of 47 (67%) patients had neurologic findings. Only one (1%) survivor had a normal neurodevelopmental follow-up. Duration of the first ECMO run (odds ratio [OR]: 2.63, 1.08-7.96), total duration on ECMO (OR: 4.72, 1.29-23.54), neurologic findings at any time (OR: 7.94, 1.46-43.24), need for renal replacement therapy (OR: 4.79, 1.06-25.58), and lactate values correlated with late mortality. All 19 (27%) patients with neurologic findings before the second run died. The frequency of multiple-run ECMOs increased within the study period. Outcomes in pediatric patients with multiple ECMO runs are disheartening. Given all patients in our cohort with neurological findings before the second ECMO run died, neurological findings should be taken into consideration when determining the utility of further ECMO support.

Why Aren't There More Whistleblowers?

AbstractIn The Occasional Human Sacrifice: Medical Experimentation and the Price of Saying No, bioethicist Carl Elliot seeks to understand people who blow the whistle on unethical human research projects. The book compares whistleblowers in six scandals, and Elliot's main explanation for why someone becomes a whistleblower is personal honor. Exploring what led to or might have prevented these scandals, Elliot is critical of institutional review boards, and he links research ethics violations to injustices in everyday clinical care and medical training and to power imbalances in medical institutions. Some of the clinical and scientific details in the cases suggest other moral and ethical problems and the increasing irrelevance of the practice‐research distinction. Whistleblowers are also needed for the mass experiments that occur when practices diffuse without robust evidence and for the structural inequalities on which American clinical care, teaching, and research depend.

How Idiographic Methodologies Can Move the Clinical-Science Field Forward to Integrate Personalized Treatment Into Everyday Clinical Care and Improve Treatment Outcomes

The research–practice gap refers to the fact that most evidence-based treatments created by researchers are not used in routine clinical care, which affects real-world treatment outcomes negatively. One key reason that evidence-based care is not used more frequently is its nonpersonalized format. For example, most evidence-based treatments are based on averages and are limited in addressing comorbidity, heterogeneity, and the needs of clients with minoritized identities. These limitations reduce therapist uptake of evidence-based treatment at large. As a result, most patients seeking treatment in community settings do not receive evidence-based care, which could more quickly and effectively reduce mental-health suffering. Furthermore, even clinicians who want to engage in evidence-based practice must still rely on their clinical judgment in decision-making when treatments fail to address client-specific needs. This reliance on decision-making can influence outcomes negatively. We propose that idiographic (i.e., one-person; N = 1) methodologies (data analysis of one person’s data) combined with digital mental-health technology could help reduce the research–practice gap and improve treatment outcomes. In this article, we outline the many issues contributing to these problems and how idiographic methods of personalization can address these issues. We provide an overview of idiographic methodologies and examples of how to use these methods to personalize existing evidence-based treatments with patients. Finally, we conclude with recommendations for future research and movement within the field that is needed to propel this type of personalization into routine clinical care to reduce the research–practice gap and improve treatment outcomes broadly.

Chemotherapy-related adverse effects with anthracycline and taxane-containing regimens in patients with localized Breast cancer: a descriptive study

BackgroundAlthough the side effects of chemotherapy are frequently described in research studies, there is little evidence on how common they are in everyday clinical care. This study’s goal was to assess the most prevalent short-term side effects experienced by patients with localized breast cancer, undergoing chemotherapy based on anthracyclines and taxane-containing treatments, at the medical oncology department of the Mohammed VI University Hospital of Marrakech, Morocco.MethodsThis was a descriptive study. We conducted a listening session at the outpatient department of the hospital with the help of a structured questionnaire. The session engaged 122 women who had undergone cycles of chemotherapy. A chi-square test was used to compare the incidence and relative risk of short side effects with both anthracycline and taxane-containing regimens.ResultsThe average age of participants was 49.1 years. In both regimens, the findings highlighted the frequency and relative risk of the following adverse effects: systemic symptoms (fever, asthenia and sleep disorder), gastrointestinal toxicity (Vomiting, nausea, diarrhoea, constipation, mucositis and loss of appetite), dermatological toxicity (Skin reactions on hands/feet, nail toxicity, allergies, alopecia and peripheral edema), neurological toxicity (neuropathy), arthromyalgia and ocular toxicity.ConclusionsIn conclusion, it is crucial for healthcare professionals to be conscious of the significance of these adverse effects. They must also know how to manage them. Likewise, the listening approach highlights its importance in the daily follow-up and monitoring of patients.

Rehabilitation Treatment Specification System for Voice Therapy: Application to Everyday Clinical Care.

Rehabilitation intervention descriptions often do not explicitly identify active ingredients or how those ingredients lead to changes in patient functioning. The Rehabilitation Treatment Specification System (RTSS) provides guidance to identify the critical aspects of any rehabilitation therapy and supported the development of standardly named ingredients and targets in voice therapy (Rehabilitation Treatment Specification System for Voice Therapy [RTSS-Voice]). This study sought to test the content validity of the RTSS-Voice and determine if the RTSS-Voice can be used to identify commonalities and differences in treatment (criterion validity) across clinicians in everyday clinical practice. Five speech-language pathologists from different institutions videotaped one therapy session for 59 patients diagnosed with a voice or upper airway disorder. Specifications were created for each video, and iterative rounds of revisions were completed with the treating clinician and two RTSS experts until consensus was reached on each specification. All 59 sessions were specified without the addition of any targets or ingredients. There were two frequent targets: (a) increased volition and (b) decreased strained voice quality. There were three frequent ingredients: (a) information regarding the patient's capability and motivation to perform a therapeutic behavior, (b) knowledge of results feedback, and (c) opportunities to practice voicing with improved resonance and mean airflow. Across sessions treating vocal hyperfunction, there was large variability across clinicians regarding the types and number of treatment components introduced, types of feedback provided, and vocal practice within spontaneous speech and negative practice. The RTSS and the RTSS-Voice demonstrated strong content validity, as they comprehensively characterized 59 therapy sessions. They also demonstrated strong criterion validity, as commonalities and differences were identified in everyday voice therapy for vocal hyperfunction across multiple clinicians. Future work to translate RTSS principles and RTSS-Voice terms into clinical documentation can help to understand how clinician and patient variability impacts outcomes and bridge the research-practice gap. https://doi.org/10.23641/asha.24796875.

Workshop 5: Mitigating Ageism in Everyday Clinical Care

Learning objectives:At the end of this workshop, participants will be able to: -Integrate a human rights and dignity-based strategies into daily clinical care for older persons with mental health conditions-Identify the effects of intersections of ageism, ableism, mentalism and elder abuse on the care provided to older persons with mental health conditions-Describe and support the need for an international (UN) Convention on the rights of older persons to improve the care of older persons with mental health conditionsBackground:Our world faces rapid population aging. Based on the WHO estimates, nearly 20% of older persons will have mental health conditions such as dementia, depression, anxiety and substance use, often complicated by physical and psychosocial comorbidities. Various mental health inequalities exist in this vulnerable population negatively influencing their healthcare and social status. This includes the ‘triple jeopardy’ of ageism, ableism and mentalism. The ongoing COVID-19 crisis has only widened the marginalization of older persons and especially those with mental health conditions.Methods:Even though there has been a paradigm-shift in neurobiological understanding of psychogeriatrics, dignity-based mental healthcare is still silent in research as well as practice. This workshop brings in recommendations to include the principles of rights, dignity, equality, equity and respect in clinical care for older persons living with mental health conditions, including dementia. These suggestions are based on literature review, position statements of global organizations working in this area, the Decade enablers of the UN Decade of Healthy Aging (2021-2030) and also clinical experience of the authors. Special focus will be on end-of-life care, advance directives and those in institutionalized settings.Mode of conduction:The workshop will involve a strategic and interactive discussion based on real-life case vignettes. Feedback will be sought on the perceived status of dignity and human rights in current clinical practice. Focus will be on ensuring dignity and promoting human rights in routine clinical care and patient-physician communication, age-friendly healthcare settings for older persons and the role of dignity therapy. The need for an International Convention for the rights of older persons will also be highlighted with evidence.Elder abuse and inadequate end-of-life care as two of the many common manifestations of the implicit bias and core root cause of the phenomenon of the “ageism spectrum”. Ensuring dignity and human rights in older persons can combat ageism and prevent elder abuse. Adequate sensitivity and training of professionals in this area will set the future pathway for dignified mental health interventions in the older persons with mental health conditions that are devoid of age-based discrimination and prejudice.

Addressing clinician moral distress: Implications from a mixed methods evaluation during Covid-19.

Clinician moral distress has been documented over the past several decades as occurring within numerous healthcare disciplines, often in relation to clinicians' involvement in patients' end-of-life decision-making. The resulting harms impact clinician well-being, patient well-being, and healthcare system functioning. Given Covid-19's catastrophic death toll and associated demands on end-of-life decision-making processes, the pandemic represents a particularly important context within which to understand clinician moral distress. Thus, we conducted a convergent mixed methods study to examine its prevalence, associations with clinicians' demographic and professional characteristics, and contributing circumstances among Veterans Health Administration (VA) clinicians. The study, conducted in April 2021, consisted of a cross-sectional on-line survey of VA clinicians at 20 VA Medical Centers with professional jurisdiction to place life-sustaining treatment orders working who were from a number of select specialties. The survey collected quantitative data on respondents' demographics, clinical practice characteristics, attitudes and behaviors related to goals of care conversations, intensity of moral distress during "peak-Covid," and qualitative data via an open-ended item asking for respondents to describe contributing circumstances if they had indicated any moral distress. To understand factors associated with heightened moral distress, we analyzed quantitative data using bivariate and multivariable regression analyses and qualitative data using a hybrid deductive/inductive thematic approach. Mixed methods analysis followed, whereby we compared the quantitative and qualitative datasets and integrated findings at the analytic level. Out of 3,396 eligible VA clinicians, 323 responded to the survey (9.5% adjusted response rate). Most respondents (81%) reported at least some moral distress during peak-Covid. In a multivariable logistic regression, female gender (OR 3.35; 95% CI 1.53-7.37) was associated with greater odds of moral distress, and practicing in geriatrics/palliative care (OR 0.40; 95% CI 0.18-0.87) and internal medicine/family medicine/primary care (OR 0.46; 95% CI 0.22-0.98) were associated with reduced odds of moral distress compared to medical subspecialties. From the 191 respondents who completed the open-ended item, five qualitative themes emerged as moral distress contributors: 1) patient visitation restrictions, 2) anticipatory actions, 3) clinical uncertainty related to Covid, 4) resource shortages, and 5) personal risk of contracting Covid. Mixed methods analysis found that quantitative results were consistent with these last two qualitative themes. In sum, clinician moral distress was prevalent early in the pandemic. This moral distress was associated with individual-, system-, and situation-level contributors. These identified contributors represent leverage points for future intervention to mitigate clinician moral distress and its negative outcomes during future healthcare crises and even during everyday clinical care.

Knowledge of Complementary and Integrative Health among Collegiate Athletic Trainers

Purpose: Complementary and integrative health (CIH) interventions are non-mainstream modalities used to complement traditional care and are used by athletic trainers. Interventions encompassing CIH can help provide holistic care that is patient-centered. However, there is no previous research on the attitudes and use of CIH in everyday clinical care. The purpose of this project is to investigate athletic trainers’ use and attitudes towards CIH interventions. Methods: A cross-sectional, web-based survey including demographics, CIH integration, and the Complementary Health Belief Questionnaire (CHBQ) was sent out to a random sample of athletic trainers. Measures of central tendency were calculated to characterize the behaviors and use of CIH by athletic trainers. The scores on the CHBQ were averaged and an independent t-test was used to compare the CHBQ scores between athletic trainers who use CIH and those who do not. Results: The average total score for the CHBQ is 43.41±4.26, indicating generally positive beliefs and attitudes towards CIH interventions. There were no statistical differences in CHBQ scores between athletic trainers who use CIH interventions and those who do not, indicating both groups have positive attitudes towards CIH intervention. Further, the most common interventions used by athletic trainers were massage, yoga, and chiropractic care. Conclusion: Many collegiate athletic trainers incorporate CIH interventions into their practice and tend to have positive attitudes towards CIH. In order to treat the whole patient, athletic trainers should consider incorporating CIH interventions into their practice in order to assist in positive patient reported outcomes.

Clinical trials: A plea to cooperative groups, consortia, pharmaceutical companies, and lead investigators for reasonable imaging protocols.

Clinical trials: A plea to cooperative groups, consortia, pharmaceutical companies, and lead investigators for reasonable imaging protocols.

Diabetes Technology and the Human Factor.

Diabetes Technology and the Human Factor.

The Logics of Invited and Uninvited Material Participation

This paper addresses debates concerning the ‘participatory turn’ in healthcare. It focuses on the case of blood pressure self-monitoring, understanding this as a form of patient participation at the level of individual care. Drawing and expanding on the work of Marres and Wynne and their notions of material participation and of uninvited engagement, we examine how patients’ home blood pressure self-monitoring is incorporated into clinical care, how the materials of blood pressure self-monitoring mediate participation and how we might characterise the practices of participation found within everyday clinical care. Our analysis makes new conceptual links, suggesting that, in this context, invited participation appears to align with participation made easy, while uninvited participation involves more invested, more engaged participation. We offer two further developments of these concepts. First, we trouble characterisations of invited and uninvited participation as distinct and separate, observing movement between these. Second, through applying the logics of material participation in a new context, everyday clinical practice, we suggest that the logic of participation made easy might be extended beyond lay people, to apply to professionals as well. Our analysis illustrates how materials are mobilised to facilitate invited and uninvited participation within the context of the on-going asymmetries in doctor patient relationships.

114 Long-term disease course in patients with atopic dermatitis receiving dupilumab therapy: Results from the TREATgermany registry

Dupilumab was approved in the EU in 2017 for the treatment of moderate-to-severe atopic dermatitis (AD). The good therapeutic response described in clinical trials has yet to be confirmed in everyday clinical care settings. The German registry TREATgermany is the largest European registry for patients with moderate to severe AD with more than 1,400 patients currently (May 2022) enrolled. Patients are prospectively monitored and clinical course, treatment, and patient-reported outcomes (PROMs) are documented.

Effects of the SARS-CoV‑2 pandemic on residency training in orthopedics and traumatology in Germany : Anationwide survey.

BackgroundThe spread of the coronavirus disease has impacted healthcare systems worldwide; however, restrictions due to the SARS-CoV‑2 (severe acute respiratory syndrome coronavirus 2) pandemic are particularly drastic for physicians in residency training. Imposed restrictions interrupt the standard educational curricula, and consequently limited residents to meet mandatory requirements.AimThe aim of this study was to evaluate the effects of the SARS-CoV‑2 pandemic on residency training in orthopedics and trauma surgery in Germany.MethodologyAn online-based, voluntary, and anonymous survey of physicians in residency training for orthopedics and trauma surgery was conducted. Through email lists of junior physician organizations the survey was sent to 789 physicians. Participation was possible between October and November 2021.ResultsA total of 95 participants (female 41.1%) with a mean age of 31.3 ± 2.8 years were analyzed. In the everyday clinical practice and care 80% of participants thought that they were set back in time of their general training due to the pandemic. There was an average reduction of 25.0% in time spent in the OR and 88.4% agreed that their surgical training was delayed due to the pandemic. Of the respondents 33.6% were able to attend external continuing education courses. Only 4.2% were able to invest more time in research and 55.8% of participants agreed that their residency training will be extended due to the pandemic.ConclusionThe COVID pandemic has had a significant impact on the residency training in orthopedics and trauma surgery in Germany. In almost all areas of training, residents had to accept restrictions due to the imposed restrictions, which potentially negatively affected their training.Supplementary InformationThe online version of this article (10.1007/s00132-022-04295-w) contains the german and english version of the survey.

WE2.2 Video Presentation of performing a Laparoscopic Cholecystectomy on a patient diagnosed with Situs Inversus Totalis

Abstract Background Situs inversus totalis (SIT) is a condition in which the arrangement of the internal organs is a mirror image of normal anatomy, occurring in 0.0001% of patients. A thorough understanding of the human anatomy and anatomical variances is crucial in everyday clinical practise and emergency surgical care. We present a video on a patient with SIT who underwent a Laparoscopic Cholecystectomy (LC). Case Our patient is a 40-year-old lady with a known diagnosis of SIT. She presented with jaundice and left upper quadrant pain (LUQ). An ultrasound and CT scan confirmed the diagnosis of gall stones, CBD stones and SIT. She underwent an ERCP to clear CBD stones. LC is one of the commonest general surgical procedures, however, this case proved challenging due to reversed anatomy. Intraoperatively, operating positioning was reversed with mirror imaging of ports used normally. Standard 10mm ports were placed in the infraumbilical and epigastric regions and the remaining ports placed in the LUQ. Abdominal organs were inspected and SIT was confirmed. It was ensured that a slow, meticulous delineation of Calot's triangle and window of safety was performed. The cystic duct and artery were clipped. The rest of the procedure was uneventful. Results The patient was discharged on the same day as the procedure. There were no immediate or short-term complications. Gallbladder histology showed chronic cholecystitis, cholelithiasis and cholesterolosis. Conclusion This case demonstrates that with appropriate planning and an advanced skill set, a LC can be performed in a patient with SIT, with little or no complications.

Using a checklist within simulation improves trainees' confidence on ward rounds

Ward rounds are integral to maintaining patient safety in everyday clinical care. Junior doctors are often expected to conduct independent rounds on graduation, but many feel ill-equipped to do so. We developed a safety checklist and simulation sessions to improve junior-led ward round practice at one district general hospital. We found that embedding a checklist within simulation is an effective way to teach ward round skills and increase confidence among undergraduate and postgraduate medical trainees.

Postoperative Delirium (POD) in Cancer Patients its Incidence and Risk Factors a Prospective Observational Study

Background: In cancer patients, surgery is an essential part of the multimodality treatment to remove solid tumors and nearly 50% of the cancer patients underwent surgery for the treatment of cancer usually experienced post-operative delirium (POD). Currently, screening for delirium in the surgical wards at many cancer hospitals in China isn’t the component of everyday clinical care. Objectives: This study aims to examine the existing situation of suspected post-operative delirium in cancer patients undergoing surgery during the first 72 hours after surgery, and to identify the risk factors associated with postoperative delirium (POD). Study Design: Prospective/observational study Place and Duration: Hunan cancer Hospital. 1st December 2019 and 31st December 2019 Methods: Chinese Cancer patients scheduled for surgery, aged 18 years or elders were prospectively observed by bedside nurses for 03 consecutive postoperative days for the presence of delirium by using Nursing delirium screening scale (Nu-DESC Chinese version). Results: Among the 319 included cancer patients, 39 (12.2%) developed suspected POD. Univariate analysis showed that cancer surgical patient with comorbidity of hypertension and chronic hepatitis, surgical specialty, duration of surgery >3 hours, post-operative use of benzodiazepine and opioids to be significantly associated with suspected POD. Binary logistic regression model showed hypertension (OR 7.857 95% CI 3.484–17.718 p=<.001), chronic hepatitis (OR 44.087 95% CI 2.517–772.3 p=0.01), and duration of surgery >3 hours (OR 2.908 95% CI 1.285–6.580 p=0.01), to be independent risk factors for occurrence of suspected POD. Conclusion: The 12.2% incidence of suspected postoperative delirium (POD) in cancer patients is significant. Recognizing of cancer patients by the nurses and clinicians who may be at risk for developing POD and addressing the modifiable risk factors are extremely essential to lower the risk of its developing. Keywords: Delirium; Postoperative delirium; Cancer; risk factors; Nu-DESC

Modelling the use of variable rate intravenous insulin infusions in hospitals by comparing Work as Done with Work as Imagined.

Variable rate intravenous insulin infusions (VRIIIs) are widely used to treat elevated blood glucose (BG) in adult inpatients who are severely ill and/or will miss more than one meal. VRIIIs can cause serious harm to the patient if used incorrectly. Recent safety initiatives have embraced the Resilient Health Care (RHC) approach to safety by understanding how VRIIIs are expected to be used (Work as Imagined, 'WAI') and how it is actually used in everyday clinical care (Work as Done, 'WAD'). To systematically compare WAI and WAD and analyse adaptations used in situ to develop a model explaining VRIII use. A qualitative observational study video-recording healthcare practitioners using VRIII. The video data were transcribed and inductively coded to develop a hierarchical task analysis (HTA) to represent WAD. This HTA was compared with a HTA previously developed to represent WAI. The comparison output was used to develop a model of VRIII use. While many of the tasks in the WAD HTA were aligned with the tasks presented in the WAI HTA, some important ones did not. When misalignment was observed, permanent adaptations (e.g. signing as a witness for a changed VRIII's rate without independently verifying whether the new rate was appropriate) and temporary workarounds (e.g. not administering intermediate-acting insulin analogues although the intermediate-acting insulin prescription was not suspended) were the most frequently observed adaptations. The comparison between WAI and WAD assisted in developing a model of VRIII use. The model shed light on strategies used to imagine everyday work (e.g. incident reports, VRIII guidelines), how everyday work was accomplished (e.g. context-dependent adaptations) and how these contributed to both successful and unsuccessful outcomes. This study provided in-depth understanding of the tasks required while using VRIIIs, and responses and adaptations needed to achieve safer care in a complex environment.

Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine.

Despite the rapidly expanding knowledge in the field of Geriatric Emergency Medicine in Europe, widespread implementation of change is still lacking. Many opportunities in everyday clinical care are missed to improve care for this susceptible and growing patient group. The aim was to develop expert clinical recommendations on Geriatric Emergency Medicine to be disseminated across Europe. A group of multi-disciplinary experts in the field of Geriatric Emergency Medicine in Europe was assembled. Using a modified Delphi procedure, a prioritized list of topics related to Geriatric Emergency Medicine was created. Next, a multi-disciplinary group of nurses, geriatricians and emergency physicians performed a review of recent guidelines and literature to create recommendations. These recommendations were voted upon by a group of experts and placed on visually attractive posters. The expert group identified the following eight subject areas to develop expert recommendations on: Comprehensive Geriatric Assessment in the Emergency Department (ED), age/frailty adjusted risk stratification, delirium and cognitive impairment, medication reviews in the ED for older adults, family involvement, ED environment, silver trauma, end of life care in the acute setting. Eight posters with expert clinical recommendations on the most important topics in Geriatric Emergency Medicine are now available through https://posters.geriemeurope.eu/ . Expert clinical recommendations for Geriatric Emergency Medicine may help to improve care for older patients in the Emergency Department and are ready for dissemination across Europe.

A sociology of precision-in-practice: The affective and temporal complexities of everyday clinical care.

The idea of ‘precision medicine’, which has gained increasing traction since the early 2000s, is now ubiquitous in health and medicine. Though varied in its implementation across fields, precision medicine has raised hopes of revolutionary treatments and has spurred the proliferation of novel therapeutics, the alteration of professional trajectories and various reconfigurations of health/care. Nowhere is the promise of precision medicine more apparent, nor further institutionalised, than in the field of oncology. While the transformative potential of precision medicine is widely taken for granted, there remains scant attention to how it is being experienced at the coalface of care. Here, drawing on the perspectives of 54 cancer care professionals gleaned through eight focus group discussions in two hospitals in Australia, we explore clinicians’ experiences of the day‐to‐day dynamics of precision‐in‐practice. We illustrate some of the affective and temporal complexities, analysed here under the rubrics of enchantment, acceleration and distraction that are emerging alongside the uptake of precision medicine in the field of oncology. We argue that these complexities, and their dis/continuities with earlier iterations of cancer care, demonstrate the need for sociological analyses of precision medicine as it is being implemented in practice and its varied effects on ‘routine’ care.

Perinatal Quality and Equity-Indicators That Address Disparities.

There is tremendous attention in maternal and neonatal disparities, particularly disparities of race and ethnicity and subsequent outcomes that continue despite calls to action. The literature has offered potential opportunities for exploring data related to racial and ethnic disparities, including the utilization of a race and ethnicity reporting dashboard. This article reviews definitions of perinatal quality and disparity and provides insight into the development of a nationally targeted race and ethnicity dashboard. This quarterly dashboard provides hospitals with specific key metric outcomes through the lens of race and ethnicity, provides a national benchmark for comparison, and creates a data platform for team exploration and comprehensive review of findings. An overview of the development of the dashboard is provided, and the selection of key maternal and neonatal metrics is reviewed. In addition, recommendations for data science strategic planning and nursing's role in metric development, analysis, and utilization are offered and key steps in accelerating disparity data into everyday clinical care are discussed.