dashboards to improve VTE risk assessment and prevention Dr - - PowerPoint PPT Presentation

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dashboards to improve VTE risk assessment and prevention Dr - - PowerPoint PPT Presentation

Jun 13, 2023 15 likes •276 views

Utilising live patient dashboards to improve VTE risk assessment and prevention Dr Anthony Barberi Western Health, Victoria Medical Informatics Registrar MBBS, BDSc ..we should think twice before ordering our patients to bed and realise

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Utilising live patient dashboards to improve VTE risk assessment and prevention

Dr Anthony Barberi Western Health, Victoria Medical Informatics Registrar MBBS, BDSc

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“..we should think twice before ordering

  • ur patients to bed and realise that

beneath the comfort of the blanket there lurks a host of formidable dangers.”

Source: Dangers of going to bed, R.A.J. Asher, British Medical Journal, 13 December 1947

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Already Measured in our Institution

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Internal Policy and Procedure around management, risk stratification and prevention in place.

National Clinical Care Standard

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Venous Thromboembolism Prevention Clinical Care Standard, Australian Commission on Quality & Safety in Healthcare

Why VTE Prophylaxis?

“A large proportion of hospitalised patients are at risk for VTE, but there is a low rate of appropriate prophylaxis.” ENDORSE Study, Cohen et al, Lancet 2008

Clinical Importance Hospital Wide

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VTE prevention is seen by clinicians as an important part of patient care, in most inpatient care settings.

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Pharmacological & Patient Care Interventions

Determined based on Risk Assessment

Risk Assessment Completed

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High or Low Risk Populations

How should VTE prevention be performed in hospitals?

Reassessment Throughout

Change in clinical status Ie: Major procedures, immobility, diagnoses

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Our Goals

CLINICAL (Primary)

  • Provide Real-time data direct to clinicians and management about inpatient VTE Risk
  • Provide data to clinicians to identify anomalies in preventative measures
  • Identify at risk patients quickly

QUALITY & SAFETY

  • Demonstrate our efforts to align with Clinical Care Standards
  • Recognise at risk areas to provide support

DATA INTEGRITY

  • Improve the data quality recorded within the EMR

WORKFLOW IMPROVEMENT

  • Provide a tool to identify pitfalls in the electronic workflow
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Our Boundaries/Limitations

  • 1. Not a replacement for the patient’s record

 Limit information to users

  • 2. Not supported by clinical grade servers and IT support

 cannot replace core clinical/administrative workflows (particularly prescribing)

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Method

Power BI Dashboard Cerner EMR Medications Patient Care Tasks iPM Patient Details Patient Location & Medical team Admission Time Surgical Procedures

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It seemed like a good idea at the time…

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But when I said we were “already measuring”…

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Assessment on Discharge Reassessment every 7 days Further Assessment after any Major Procedures/Change in Clinical Status Assessment within 24 hours Admission

Clinical Care Standard Steps in Prevention

EMR Alert begins firing

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Alert Fatigue… and an exercise in human behavioural science…

Up to 40,000 alerts a month = Up to an alert approximately every minute.

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VTE Live Dashboard

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Missing Data in the Real World

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Missing Data: No Risk assessment, but being treated

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Missing Data Frank’s father has 5 sons. If the names of his 4 sons are Fefe, Fifi, Fofo, Fufu, respectively, then what would be the name of his 5th son?

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Missing Data Frank’s father has 5 sons. If the names of his 4 sons are Fefe, Fifi, Fofo, Fufu, respectively, then what would be the name of his 5th son?

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Contradictory Data: Workflow vs Knowledge Gap?

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Anomalous Results Tracker

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Historical Reporting: in the hands of clinical staff

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Future enhancement

Power BI Dashboard Cerner EMR Medications Patient Care Tasks iPM Patient Details Patient Location & Medical team Admission Time Surgical Procedures Riskman & Adverse Events Data Hospital Associated VTE complications

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Lessons Learnt & Challenges

  • Organisational Readiness for what you’re going to uncover
  • Ethics of non-action as a clinical informatics team– retrospective audits vs live data where you

can change outcomes

  • Dashboard external to clinical applications has many pros and some cons
  • Focus on accreditation standards – low hanging fruit, organisation impetus, lets you test your

system

  • Focus on well defined, well documented data points
  • Live data with clinician input helps recognise limitations in electronic workflow easier than

retrospective audits

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The Real Challenge:

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“We need to recognise that computers in healthcare don’t simply replace my doctor’s scrawl with Helvetica 12. Instead, they transform the work, the people who do it, and their relationships with one another and with patients”

  • Robert Wachter, The digital doctor
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The conceptual leap clinicians need to make…

  • Retrospective
  • Data poor
  • Too late to treat
  • More suited to auditing &

research purposes than at the coalface care

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The conceptual leap clinicians need to make…

  • Live data
  • Data rich
  • Allows active intervention at

patient level

  • Live monitoring, rather than

auditing

  • Overwhelming unless well

curated

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Thank you to the Western Health staff who actually do all the work:

Mathew Long Sean Downer Rick Horton Jen Tiet EMR Operations Team MaP Team