Innovation @ HP Labs
Insights on research, innovation, and emerging technology from HP Labs researchers around the world.

An HP Labs collaboration – the Patient Safety Dashboard – improves hospital patient care

Contributed by Simon Firth, freelance technology journalist

 

Patient Dashboard_LPCH.jpg

 

An article published this week in the medical journal Pediatrics demonstrates the potential for innovations in the field of analytics to positively impact patient health.

 

With the assistance of HP Labs researchers and funding from HP’s Living Progress, staff at the Lucile Packard Children’s Hospital (LPCH), a teaching hospital associated with the Stanford University School of Medicine, designed, built, and deployed a real-time patient status system, the Patient Safety Dashboard, in the hospital’s pediatric intensive care unit (PICU). 

 

Replacing the hand-written white boards that track patients in most hospital environments, the PICU digital white board links directly to each patient’s electronic medical record (EMR) and visually alerts care teams to potential complications, using data that is otherwise at risk of being overlooked. As reported in Pediatrics, the Dashboard’s installation resulted in a 70% decrease in catheter-related bloodstream infections, improved adherence to infection-prevention guidelines, and improved communication among medical staff.

 

“Papers that show a direct link between informatics interventions and medical outcomes are pretty rare, so this is an exciting finding,” suggests Jaap Suermondt, Vice President, Analytics at HP Labs and a study co-author.

 

“Getting better information into the hands of caregivers is something that technology can and should be doing – both to improve lives, and also to save them,” Suermondt adds. “We’re thrilled to have been part of the development of a technology solution that finds and combines information that can easily be missed, and that brings it to the eyes of the entire care team, ultimately allowing them to make critical decisions and help prevent adverse events.”

 

 

A need for better care

 

The need for improved patient care systems is undisputed. It has been well documented that tens of thousands of patients a year in the US alone experience serious adverse events in hospital settings[i]. Such events also add to the cost of medical treatment. Even when non-lethal, a single infection caused by a central venous catheter problem adds an average $30,000 to the cost of a hospital stay[ii].

 

But care delivery in high-pressure environments like pediatric ICUs is highly complex. Patients are often looked after by multiple specialists, and their notes can also be scattered in a mix of structured and unstructured information in a variety of locations, making it hard to know whether safety guidelines are being met, even in institutions that have comprehensive Electronic Medical Record (EMR) systems installed. – leading to an increased likelihood that care team members might miss some information.

 

The LPCH Patient Safety Dashboard helps lessen the likelihood of medical errors by ensuring that the entire care team can see in real time which patients are at elevated risk or are behind in their preventive care. A traffic light system in a location easily visible to all personnel turns lights on the dashboard to red, yellow, or green to signify the level of urgency with which attention is needed from medical staff to help prevent certain life-threatening complications.

 

Smaller screens, viewable only by staff and connected with the dashboard, let caregivers drill-down through a patient’s record to understand why that patient is showing a particular color on the dashboard – the records can be viewed during rounds as well as on demand, for example when a nurse checks why a specific indicator just changed from green to yellow.

 

The Pediatrics study focused in particular on the system’s reduction of catheter-associated bloodstream infections. But in using the Patient Safety Dashboard, LPCH physicians and nurses were regularly alerted to the need for a variety of other necessary and potentially life-saving procedures, including:

 

  • Taking measures to prevent pressure ulcers (bed sores) and ventilator-acquired pneumonia
  • Changing from intravenous to oral medication
  • Decreasing the use of unnecessary laboratory testing
  • Using only necessary sedatives
  • Identifying other, overdue procedures that place the patient at risk of infection

Overall, the combined use of an EMR–enhanced infection prevention checklist and the dashboard’s real-time display of adherence prompted a positive change in the care of one out of three patients during the trial period.

 

Creating a novel system that would function reliably in such a high-stakes environment wasn’t without technical challenges. In particular, notes Suermondt, “ICUs are already information-overloaded environments. So it was very important not to induce further ‘alert fatigue’ in the clinical staff. We needed to be very confident that a red alert really did mean that intervention was needed immediately and that every yellow light truly did imply an elevated risk.”

 

Getting that right required close collaboration between everyone involved in the study so that the study’s IT professionals could disable, rapidly change, and then redeploy the system’s logic whenever a false positive was detected.

 

“In the process of refining the logic and its mapping to the underlying information model, we made a number of interesting discoveries regarding inconsistencies in when and where information was being documented, differences in workflow among parts of the organization, and opportunities to improve regulatory compliance,” Suermondt recalls.

 

 

Next generation medical records

 

Two years after the dashboard’s initial deployment in the LPCH pediatric ICU, it continues to be a valued collaborative platform for ensuring that information doesn’t fall through the cracks. Nurses, residents, and attending physicians all report that it makes their jobs easier and allows them to offer a higher quality of care.

 

The dashboard has now been piloted in other units in the hospital and is being tested for hospital-wide deployment.

 

“Electronic medical records are data-rich but information-poor,” observes article lead author Dr. Natalie Pageler, a clinical assistant professor of pediatrics at the Stanford University School of Medicine and project manager for the Patient Safety Dashboard project. “This study,” she suggests, “can be seen as a first step in translating the tremendous volumes of data we now have available in a hospital’s EMR system into practical information that can guide clinical decision-making at the bedside of every patient.”

 

Significantly, the Patient Safety Dashboard interfaced with standard electronic medical record technology that is both relatively cheap and easily adaptable by other hospitals.

 

“What this collaboration demonstrates is not just that analytics can make a measurable difference – it’s also that a reliable, cost-effective solution can be deployed rapidly in clinical settings on top of their existing commercial EMR system,” Suermondt notes. “As the amount of digitally-available information grows in every aspect of our lives (not just in healthcare settings), we need more systems that help prevent critical data from getting buried and that improve situational awareness and outcomes.”

 

 

[i]  Institute of Medicine, November 1999: To Err is Human: Building a Safer Health System

[ii] Scott, RD. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. National Center for Preparedness, Detection and Control of Infectious Diseases, Centers for Disease Control, Atlanta, GA. http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.

 

 

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