Can a Novel ICU Data Display Positively Affect Patient Outcomes and Save Lives?
- 532 Downloads
The aim of this study was to quantify the impact of ProCCESs AWARE, Ambient Clinical Analytics, Rochester, MN, a novel acute care electronic medical record interface, on a range of care process and patient health outcome metrics in intensive care units (ICUs). ProCCESs AWARE is a novel acute care EMR interface that contains built-in tools for error prevention, practice surveillance, decision support and reporting. We compared outcomes before and after AWARE implementation using a prospective cohort and a historical control. The study population included all critically ill adult patients (over 18 years old) admitted to four ICUs at Mayo Clinic, Rochester, MN, who stayed in hospital at least 24 h. The pre-AWARE cohort included 983 patients from 2010, and the post-AWARE cohort included 856 patients from 2014. We analyzed patient health outcomes, care process quality, and hospital charges. After adjusting for patient acuity and baseline demographics, overall in-hospital and ICU mortality odds ratios associated with AWARE intervention were 0.45 (95% confidence interval 0.30 to 0.70) and 0.38 (0.22, 0.66). ICU length of stay decreased by about 50%, hospital length of stay by 37%, and total charges for hospital stay by 30% in post AWARE cohort (by $43,745 after adjusting for patient acuity and demographics). Better organization of information in the ICU with systems like AWARE has the potential to improve important patient outcomes, such as mortality and length of stay, resulting in reductions in costs of care.
KeywordsEMR Quality ICU
Compliance with Ethical Standards
The project described was supported by Grant Number 1C1CMS330964–01-00 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication were conducted by the awardee. Findings may or may not be consistent with or confirmed by the findings of the independent evaluation contractor.
NO and MAD have full access to all data in the study and take responsibility for the integrity and accuracy of the data analysis.
Conflict of Interest
All authors, Natalia Olchanski, Mikhail A. Dziadzko, Ing C. Tiong, Craig E. Daniels, Steve G. Peters, John C. O’Horo, MD, Michelle N. Gong, declare that he or she has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
The Institutional Review Board reviewed and approved this minimal risk study, and granted a waiver of informed consent for data collection from all individual participants included in the study.
- 1.Levinson D. Adverse events in hospitals: national incidence among Medicare beneficiaries.: US Dept of Health and Human Services, Office of Inspector General;2010.Google Scholar
- 2.Leventhal R. Research Shows Effectiveness of EMR in Positively Impacting Clinical Outcomes. Research Shows Effectiveness of EMR in Positively Impacting Clinical Outcomes. 2014. http://www.healthcare-informatics.com/news-item/research-shows-effectiveness-emr-positively-impacting-clinical-outcomes. Accessed 09/30/2015.
- 6.Ahmed, A., Chandra, S., Herasevich, V., Gajic, O., and Pickering, B.W., The effect of two different electronic health record user interfaces on intensive care provider task load, errors of cognition, and performance. Crit Care Med. 2011, 2011.Google Scholar
- 8.Elkin, P.L., Mohr, D.N., Tuttle, M.S., et al., Standardized problem list generation, utilizing the Mayo canonical vocabulary embedded within the unified medical language system. Proc AMIA Annu Fall Symp.:500–504, 1997.Google Scholar
- 17.Sevilla Berrios RA, Kaur S, Erdogan A, et al. ProcessAWARE: Patient Outcomes and Resource Utilization Changes following Implementing an Electronic Rounding Checklist in the Intensive Care Unit AMIA 2014 proceedings. 2014:1580.Google Scholar
- 18.Erdogan A, Kaur S, Garcia Arguello LY, et al. Process Improvements from Implementing an Electronic Checklist and Rounds Choreography to the Intensive Care Unit AMIA 2014 proceedings. 2014:1379.Google Scholar
- 19.Thongprayoon, C., Harrison, A.M., O'Horo, J.C., Berrios, R.A., Pickering, B.W., and Herasevich, V., The effect of an electronic checklist on critical care provider workload, errors, and performance. J Intensive Care Med., 2014.Google Scholar
- 22.Magill, S.S., Klompas, M., Balk, R., et al., Developing a new, national approach to surveillance for ventilator-associated events*. Crit Care Med:2013, 2013.Google Scholar