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Evaluating a novel, integrative dashboard for health professionals' performance in managing deteriorating patients: a quality improvement project

Alhmoud, B; Melley, D; Khan, N; Bonicci, T; Patel, R; Banerjee, A; (2022) Evaluating a novel, integrative dashboard for health professionals' performance in managing deteriorating patients: a quality improvement project. BMJ Open Quality , 11 (4) , Article e002033. 10.1136/bmjoq-2022-002033. Green open access

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Abstract

Background The quality of recording and documentation of deteriorating patient management by health professionals has been challenged during the COVID-19 pandemic. Non-adherence to escalation and documentation guidelines increases risk of serious adverse events. Electronic health record (EHR)-integrated dashboards are auditing tools of patients' status and clinicians' performance, but neither the views nor the performance of health professionals have been assessed, relating to management of deteriorating patients. Objective To develop and evaluate a real-time dashboard of deteriorating patients' assessment, referral and therapy. Settings Five academic hospitals in the largest National Health Service (NHS) trust in the UK (Barts Health NHS Trust). Intervention The dashboard was developed from EHR data to investigate patients with National Early Warning Score (NEWS2)>5, assessment, and escalation of deteriorating patients. We adopted the Plan, Do, Study, Act model and Standards for Quality Improvement Reporting Excellence framework to evaluate the dashboard. Design Mixed methods: (1) virtual, face-to-face, interviews and (2) retrospective descriptive EHR data analysis. Results We interviewed three nurses (two quality and safety and one informatics specialists). Participants perceived the dashboard as a facilitator for auditing NEWS2 recording and escalation of care to improve practice; (2) there is a need for guiding clinicians and adjusting data sources and metrics to enhance the functionality and usability. Data analysis (2019-2022) showed: (1) NEWS2 recording has gradually improved (May 2021-April 2022) from 64% to 83%;(2) referral and assessment completion increased (n: 170-6800 and 23-540, respectively). Conclusion The dashboard is an effective real-time data-driven method for improving the quality of managing deteriorating patients. Integrating health systems, a wider analysis NEWS2 and escalation of care metrics, and clinicians' learning digital solutions will enhance functionality and experience to boost its value. There is a need to examine the generalisability of the dashboard through further validation and quality improvement studies.

Type: Article
Title: Evaluating a novel, integrative dashboard for health professionals' performance in managing deteriorating patients: a quality improvement project
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmjoq-2022-002033
Publisher version: https://doi.org/10.1136/bmjoq-2022-002033
Language: English
Additional information: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10162486
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