Chemparathy Augustine, Seneviratne Martin G, Ward Andrew, Mirchandani Simran, Li Ron, Mathew Roshni, Wood Matthew, Shin Andrew Y, Donnelly Lane F, Scheinker David, Lee Grace M
Department of Management Science and Engineering, Stanford University, Stanford, Calif.
Department of Biomedical Informatics, Stanford University, Stanford, Calif.
Pediatr Qual Saf. 2021 Jun 23;6(4):e431. doi: 10.1097/pq9.0000000000000431. eCollection 2021 Jul-Aug.
Central line-associated bloodstream infections (CLABSIs) are the most common hospital-acquired infection in pediatric patients. High adherence to the CLABSI bundle mitigates CLABSIs. At our institution, there did not exist a hospital-wide system to measure bundle-adherence. We developed an electronic dashboard to monitor CLABSI bundle-adherence across the hospital and in real time.
Institutional stakeholders and areas of opportunity were identified through interviews and data analyses. We created a data pipeline to pull adherence data from twice-daily bundle checks and populate a dashboard in the electronic health record. The dashboard was developed to allow visualization of overall and individual element bundle-adherence across units. Monthly dashboard accesses and element-level bundle-adherence were recorded, and the nursing staff's feedback about the dashboard was obtained.
Following deployment in September 2018, the dashboard was primarily accessed by quality improvement, clinical effectiveness and analytics, and infection prevention and control. Quality improvement and infection prevention and control specialists presented dashboard data at improvement meetings to inform unit-level accountability initiatives. All-element adherence across the hospital increased from 25% in September 2018 to 44% in December 2019, and average adherence to each bundle element increased between 2018 and 2019.
CLABSI bundle-adherence, overall and by element, increased across the hospital following the deployment of a real-time electronic data dashboard. The dashboard enabled population-level surveillance of CLABSI bundle-adherence that informed bundle accountability initiatives. Data transparency enabled by electronic dashboards promises to be a useful tool for infectious disease control.
中心静脉导管相关血流感染（CLABSI）是儿科患者中最常见的医院获得性感染。严格遵守CLABSI综合预防措施可降低CLABSI的发生率。在我们机构，此前没有一个全院范围的系统来衡量对综合预防措施的遵守情况。我们开发了一个电子仪表盘，以实时监测全院范围内对CLABSI综合预防措施的遵守情况。
通过访谈和数据分析确定机构利益相关者和机会领域。我们创建了一个数据管道，从每日两次的综合预防措施检查中提取遵守数据，并在电子健康记录中填充一个仪表盘。该仪表盘的开发旨在实现各科室综合预防措施整体及各单项要素遵守情况的可视化。记录每月仪表盘的访问情况和要素级别的综合预防措施遵守情况，并收集护理人员对仪表盘的反馈。
2018年9月部署后，主要是质量改进、临床效果与分析以及感染预防与控制部门访问该仪表盘。质量改进和感染预防与控制专家在改进会议上展示仪表盘数据，以推动科室层面的问责举措。全院所有要素的遵守率从2018年9月的25%提高到2019年12月的44%，并且在2018年至2019年期间，每个综合预防措施要素的平均遵守率都有所提高。
在部署实时电子数据仪表盘后，全院范围内CLABSI综合预防措施的整体及各要素遵守率均有所提高。该仪表盘实现了对CLABSI综合预防措施的全院层面监测，为综合预防措施问责举措提供了依据。电子仪表盘实现的数据透明度有望成为传染病控制的有用工具。
