SHORT SCIENTIFIC SESSION
Chairs
  • Robert Blokpoel, Netherlands
  • Andrea Wolfler, Italy
Room
Mozart Hall 1
Date
20.06.2019
Session Time
11:10 - 12:10

Session Webcast

BIG DATA IN THE INTENSIVE CARE UNIT: WILL IT HELP?

Presenter
  • Luregn Schlapbach, Australia
Authors
  • Luregn Schlapbach, Australia
Room
Mozart Hall 1
Date
20.06.2019
Session Time
11:10 - 12:10
Session Name
Duration
20 Minutes

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VIRTUAL PEDIATRIC SYSTEMS, LLC: A NORTH AMERICAN PICU REGISTRY SUPPORTING QUALITY IMPROVEMENT AND RESEARCH

Presenter
  • Randall Wetzel, United States of America
Authors
  • Nancy Brundage, United States of America
  • Randall Wetzel, United States of America
  • Brian Reisner,
Room
Mozart Hall 1
Date
20.06.2019
Session Time
11:10 - 12:10
Session Name
Duration
10 Minutes

Abstract

Background

Background: Improving quality often relies on benchmarking and research. Virtual Pediatric Systems, LLC (“VPS”) has supported the North American PICU community since 2002 with high quality data aggregation from over 160 hospitals collecting severity adjusted data with over 1.4 million admissions (140,000 cardiac). VPS is the largest pediatric collaborative quality improvement and research registry and provides comprehensive benchmarking.

Objectives

Objective: To report the VPS experience providing analytics, reporting, research and quality improvement for PICUs.

Methods

Methods and Results: VPS records were reviewed to provide information. All VPS comparative reports are adjusted for severity of illness. VPS provides data validation, reporting and statistical support. All programing is done in house. VPS data security is certified by HiTrust. In the last ten years over 5,000 annual and quarterly reports have been provided to participating ICUs. Data has been provided for 237 research papers (see figure). Hundreds of quality improvement projects have been undertaken. VPS has a members’ medical advisory committee, supports quality improvement collaboratives, provides near real time dashboards and ad hoc reporting for its members. There are periodic user group meetings. Several states either require or are considering mandatory VPS participation.

Results

Results Data: espnic2019.vps..png

Conclusion

Conclusions: VPS provides innovative, comprehensive, detailed and actionable quality reports for practitioners and administrators and supports improved quality of critical care and has become the largest PICU research collaborative.

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A MULTI-DIMENSIONAL GLOBAL QUALITY PERFORMANCE SCORE FOR COMPARING PICUS

Presenter
  • Randall Wetzel, United States of America
Authors
  • Gerardo Soto-Campos, United States of America
  • Jamie Palumbo,
  • Randall Wetzel, United States of America
Room
Mozart Hall 1
Date
20.06.2019
Session Time
11:10 - 12:10
Session Name
Duration
10 Minutes

Abstract

Background

Quality improvement is frequently assessed by benchmarking, often one-dimensionally using Standardised Mortality Ratios (SMR).

Objectives

Development of a multidimensional score to compare PICUs.

Methods

Virtual Pediatric Systems, LLC (VPS) data from 147 PICUs (82,000 admissions) was analysed. Performance metrics included (weights in parenthesis): SMR (2), standardized length of stay ratio (1), discharge delay (1) while other metrics (1) assessed deviation from cohort average (standard) performance: 24-h readmissions, extubation failure, use of mechanical ventilation, and discharge directly home (0.5). For metrics, differences between individual ICU metric and standard care were calculated. Percentile ranges 0-10 (best), 10-20, 20-50, 50-80, 89-90, and 90-100 (worst) were converted to metric-scores, 6, 5, 4, 3, 2, and 1. The unit global score was the weighted sum of metric-scores scaled to 100. The heatmap (figure) shows metrics (rows) and 16 ICUs (columns). Performance above or below the standard is indicated (+/-).

Results

ICU performance is ranked by the multidimensional global score. The figure shows a highlighted hospital (score 73) compared to 15 reference ICUs. The figure demonstrates individual relative metric performance, highlighting ICU strengths and weaknesses.

heatmappicturecolor.jpg

Conclusion

This multidimensional score permits ICU benchmarking and also allows numerical and visual comparisons.

Global score rankings could be used to rate ICUs, for example, 3 stars for 90-100%, 2 for 50-89%, one for 10-49% and <10% not rated.

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  • 1 17.12.2019 14:35
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COMBINED STRATEGY FOR INCREASING INCIDENT REPORTS - DIDACTIC LECTURES AND IMMEDIATE FEEDBACK OF ROOT CAUSE ANALYSIS IN PICU

Presenter
  • Yoko Akamine, Japan
Authors
  • Yoko Akamine, Japan
  • Atsushi Ujiro, United States of America
  • Yasunori Otsuka, United States of America
  • Hiroshi Yamamoto, United States of America
  • Taiki Haga, United States of America
  • Hirofumi Iwata, United States of America
  • Hikoaki Ohba, United States of America
  • Takao Kazuta, United States of America
Room
Mozart Hall 1
Date
20.06.2019
Session Time
11:10 - 12:10
Session Name
Duration
10 Minutes

Abstract

Background

Physicians report less incidents than nurses. Factors that hinder physicians from reporting incidents are known as fear of punitive action, legal ramifications, belief that only bad doctors make mistakes. However, even low level incidents are rich sources of learning. How can we raise awareness for patient safety with creating non-punitive culture and increase reports from physicians?

Objectives

To create non-punitive culture and increase the number of incident reports from physicians, we conducted single-center prospective interventional study in our ten-bed PICU.

Methods

The monthly number of incident reports by physicians from January to December 2018 were compared pre- and post-intervention periods using independent two-tailed t-test. The intervention was consisted of two parts, starting in July 2018. One of the interventions was the series of didactic lectures for raising awareness of importance of non-punitive patient safety culture, the other was immediate feedback of solutions derived from regular team-based root cause analysis to the staffs.

Results

The number of incident reports was significantly increased in the period of post-intervention compared with pre-intervention (P<0.001).

incident reports jpeg 3.jpg

Conclusion

Combined strategy consisted of educational lectures to raise awareness of importance of non-punitive patient safety culture and immediate feedback of solutions derived from root cause analysis of reported incidents had significant impact on increasing incident reports from physicians in our PICU. Educational lectures might provide basic understanding of non-punitive culture and how incident reporting system benefit both patients and healthcare providers. Immediate feedback of root cause analysis might provide specific solutions that motivate them to report more incidents as rich sources of learning.

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OPTIMIZING ASSESSMENT OF PAIN, AGITATION AND WITHDRAWAL IN THE PICU: A QUALITY IMPROVEMENT INITIATIVE TO REDUCE IATROGENIC WITHDRAWAL 

Presenter
  • Tatiana Z. Sampaio, Canada
Authors
  • Tatiana Z. Sampaio, Canada
  • Colleen Fitzgibbons, Canada
  • Nisha Varughese,
  • Rebecca Giamberardino,
  • Rebecca Brooke,
  • Erin Larmer,
  • Sonny Dhanani,
Room
Mozart Hall 1
Date
20.06.2019
Session Time
11:10 - 12:10
Session Name
Duration
10 Minutes

Abstract

Background

Iatrogenic withdrawal syndrome (IWS) is a frequent serious complication in pediatric critical care. In 2016, at the Children’s Hospital of Eastern Ontario, IWS affected more than 80% of high-risk patients; a higher incidence than usually reported in the literature.

Objectives

This quality improvement project aimed to decrease the incidence of IWS in patients intubated and ventilated in our PICU.

Methods

A series of interventions to decrease exposure to opioids and sedatives were adopted: education; a new pain scale; and optimization of assessment and documentation of pain, agitation and withdrawal symptoms. The variables collected by electronic medical record (EMR) reports and bedside audits were monitored on control charts.

Results

From a total of 382 intubated and ventilated patients, admitted from January 2017 to September 2018, 151 patients were assessed for IWS with using the Withdrawal Assessment Tool, version 1 (WAT-1). The figure 1 shows the incidence of IWS in assessed patients and the percentage of intubated patients assessed for IWS. Initially, the high incidence of IWS decreased with education until October 2017 when started to increase again. This coincides with the implementation of a new EMR system which prompted a steep increase in the percentage of patients assessed for withdrawal, showing that the initial incidence of IWS was underestimated. Unplanned extubation, severe pain or undersedation were not affected by the interventions

Conclusion

The incidence of IWS was reduced by 20% after 2 years of improvements. The next steps will include embedding the sedation and analgesia protocol in order sets through EMR.

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