An alert tool to promote lung protective ventilation for possible acute respiratory distress syndrome.
An alert tool to promote lung protective ventilation for possible acute respiratory distress syndrome.
复制标题
一种针对可能的急性呼吸窘迫综合征促进肺保护性通气的警报工具。
DOI：
10.1093/jamiaopen/ooac050
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发表时间：
2022-07
期刊：
影响因子：
2.1
通讯作者：
Grissom, Colin K.
中科院分区：
文献类型：
--
作者：
Knighton, Andrew J.;Kuttler, Kathryn G.;Ranade-Kharkar, Pallavi;Allen, Lauren;Throne, Taylor;Jacobs, Jason R.;Carpenter, Lori;Winberg, Carrie;Johnson, Kyle;Shrestha, Neer;Ferraro, Jeffrey P.;Wolfe, Doug;Peltan, Ithan D.;Srivastava, Rajendu;Grissom, Colin K.
关键词：
计算机辅助决策工具可以加快对急性呼吸窘迫综合征（ARDS）的识别，并促进使用肺保护性通气（LPV）进行一致、及时的治疗。本研究通过部署和使用与现有计算机呼吸机方案相关的临床决策支持（CDS）同步警报工具，以及针对未接受LPV的可能ARDS患者，评估了实施和服务（过程）结果。我们于2019年12月至2020年11月进行了一项解释性混合方法研究，以评估综合医疗系统中13个重症监护病房（ICU）的CDS警报实施结果，该系统每年有4000名机械通气患者。我们使用定量方法来衡量服务结果，包括CDS警报工具的利用率、准确性和实施有效性。对CDS工具的适当性和可接受性的态度通过对医生和高级实践提供者的电子实地调查进行评估。38%的研究对象至少有一次LPV不依从发作。与单独使用疾病检测逻辑相比，添加LPV治疗检测逻辑可避免估计1812条警报消息（41%）。48%的预警建议在2小时内实施。与金标准ARDS判定相比，预警准确率估计为63%，敏感性为85%，阳性预测值为62%。57%的受访者观察到警报带来的一个或多个好处。引入基于ARDS风险因素的CDS警报工具，并与计算机化呼吸机方案指令相结合，提高了LPV使用差距的可视性，并促进了LPV的坚持。
Computer-aided decision tools may speed recognition of acute respiratory distress syndrome (ARDS) and promote consistent, timely treatment using lung-protective ventilation (LPV). This study evaluated implementation and service (process) outcomes with deployment and use of a clinical decision support (CDS) synchronous alert tool associated with existing computerized ventilator protocols and targeted patients with possible ARDS not receiving LPV. We performed an explanatory mixed methods study from December 2019 to November 2020 to evaluate CDS alert implementation outcomes across 13 intensive care units (ICU) in an integrated healthcare system with >4000 mechanically ventilated patients annually. We utilized quantitative methods to measure service outcomes including CDS alert tool utilization, accuracy, and implementation effectiveness. Attitudes regarding the appropriateness and acceptability of the CDS tool were assessed via an electronic field survey of physicians and advanced practice providers. Thirty-eight percent of study encounters had at least one episode of LPV nonadherence. Addition of LPV treatment detection logic prevented an estimated 1812 alert messages (41%) over use of disease detection logic alone. Forty-eight percent of alert recommendations were implemented within 2 h. Alert accuracy was estimated at 63% when compared to gold standard ARDS adjudication, with sensitivity of 85% and positive predictive value of 62%. Fifty-seven percent of survey respondents observed one or more benefits associated with the alert. Introduction of a CDS alert tool based upon ARDS risk factors and integrated with computerized ventilator protocol instructions increased visibility to gaps in LPV use and promoted increased adherence to LPV.
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影响因子：
8.8
作者：
Herasevich, Vitaly;Tsapenko, Mykola;Gajic, Ognjen
通讯作者：
Gajic, Ognjen
影响因子：
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作者：
Knighton, Andrew J;Kean, Jacob;Srivastava, Raj
通讯作者：
Srivastava, Raj
影响因子：
15.1
作者：
Lanspa, Michael J.;Peltan, Ithan D.;Grissom, Colin K.
通讯作者：
Grissom, Colin K.
DOI：
10.1186/s13012-017-0644-2
发表时间：
2017-09-15
期刊：
Implementation science : IS
影响因子：
--
作者：
Liberati EG;Ruggiero F;Galuppo L;Gorli M;González-Lorenzo M;Maraldi M;Ruggieri P;Polo Friz H;Scaratti G;Kwag KH;Vespignani R;Moja L
通讯作者：
Moja L
影响因子：
8.8
作者：
Kalhan, R;Mikkelsen, M;Fuchs, BD
通讯作者：
Fuchs, BD