3.8 Article

Use of a Portable Electronic Interface Improves Clinical Handoffs and Adherence to Lung Protective Ventilation

Journal

MEDICAL DEVICES-EVIDENCE AND RESEARCH
Volume 15, Issue -, Pages 263-275

Publisher

DOVE MEDICAL PRESS LTD
DOI: 10.2147/MDER.S372333

Keywords

respiration; lung protective ventilation; handoff; respiratory therapy; clinical decision support software; health information technology

Funding

  1. National Institute of Health - National Heart, Lung, and Blood research [1R43HL146012-01A1]

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This study aims to explore an electronic platform adapted to a hand-held tablet that displays real-time ventilatory parameters to increase clinician awareness of key LPV parameters. Additionally, a handoff checklist is created to improve shift-change communication. Results from a simulated environment show that using this system significantly reduces the time above guideline Pplat and the time outside the VT range, while improving the quality of clinician handoffs.
Background: Mechanical ventilation (MV) is used to support patients with respiratory impairment. Evidence supports the use of lung-protective ventilation (LPV) during MV to improve outcomes. However, studies have demonstrated poor adherence to LPV guidelines. We hypothesized that an electronic platform adapted to a hand-held tablet receiving real-time ventilatory parameters could increase clinician awareness of key LPV parameters. Furthermore, we speculated that an electronic shift-change tool could improve the quality of clinician handoffs. Methods: Using a specially designed Wi-Fi dongle to transmit data from three ventilators and a respiratory monitor, we implemented a system that displays data from all ventilators under the care of a Respiratory Care Practitioner (RCP) on an electronic tablet. In addition, the tablet created a handoff checklist to improve shift-change communication. In a simulated ICU environment, we monitored the performance of eight RCPs at baseline and while using the system. Results: Using the system, the time above guideline Pplat decreased by 74% from control, and the time outside the VT range decreased by 60% from control, p = 0.007 and 0.015, respectively. The handoff scores improved quality significantly from 2.8 to 1.6 on a scale of 1 to 5 (1 being best), p = 0.03. Conclusion: In a simulated environment, an electronic RT tool can significantly improve shift-change communication and increase the RCP's level of LPV adherence.

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