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

Abstract

Objectives: Sedation minimization and ventilator liberation protocols improve outcomes but are challenging to implement. We sought to demonstrate proof-of-concept and impact of an electronic application promoting sedation minimization and ventilator liberation. Design: Multi-ICU proof-of-concept study and a single ICU before-after study. Setting: University hospital ICUs. Patients: Adult patients receiving mechanical ventilation. Interventions: 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. Measurements and Main Results: 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. Conclusions: 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.

Promoting Evidence-Based Practice in Acute Respiratory Distress Syndrome: A Systematic Review

“…Electronic tools (i.e., interactive prompts, alerts, and reminders in the electronic health record) may increase adherence to evidence-based practice and guideline recommendations ( 26 – 29 ) and implementation of clinical algorithms in medicine ( 30 , 31 ). However, the utility of such tools could be limited by provider override or disregard of prompts ( 32 ) and alert fatigue ( 33 ).…”

The Rapid Implementation of Ad Hoc Tele-Critical Care Respiratory Therapy (eRT) Service in the Wake of the COVID-19 Surge

“…Requests for specialized RT services could come from the ICUs (site-trigger). Requests for eRT services could also be automatically generated using an alert from -the medical record or an electronic "sniffer" aimed at detecting ARDS or sepsis [17][18][19]. Finally, other teleICU staff could request the attention of the eRT to certain problems they encountered while performing their tasks (eTriage).…”

Nudging healthcare professionals to improve treatment of COVID-19: a narrative review

“…5545926 for full view). Four studies related to ventilation of intubated patients, [18][19][20][21] five targeted hand hygiene measures, [22][23][24][25][26] six focused on increasing vaccination rates [27][28][29][30][31][32] and five focused on encouraging judicious antibiotic prescription. [33][34][35][36][37] Out of the 20 studies included for analysis, seven employed more than one medium of intervention, and 13 employed only one.…”

“…Anderson et al 21 reduced the duration of mechanical ventilation (MV) and intensive care unit (ICU) length of stay by implementing an electronic dashboard and alert system to promote sedation minimisation and ventilator liberation. The intervention consisted 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 ventilator support; and (2) text-message alerts once patients met the criteria for spontaneous breathing and spontaneous awakening trials.…”