Jyothsna Giri

The implementation of clinician designed, human-centered electronic medical record viewer in the intensive care unit: A pilot step-wedge cluster randomized trial

OBJECTIVES AWARE (Ambient Warning and Response Evaluation) is a novel electronic medical record (EMR) dashboard designed by clinicians to support bedside clinical information management in the ICU. AWARE sits on top of pre-existing, comprehensive EMR systems. The purpose of the study was to test the acceptance and impact of AWARE on data management in live clinical ICU settings. The primary outcome measure was observed efficiency of data utilization as determined by time spent in data gathering before morning rounds. DESIGN Step wedge cluster randomization trial. SETTING Four ICUs (surgical, medical, and mixed) at an academic referral center. SUBJECTS All members of the critical care team participating in morning ICU rounds. INTERVENTION Pilot implementation of a novel EMR interface with direct observation and survey. MEASUREMENTS AND MAIN RESULTS The study took place between April and July 2012. A total of 80 and 63 direct observations were made in the pre- and post-implementation study periods respectively. The time spent on pre-round data gathering per patient decreased from 12 (10-15) to 9 (7.3-11) min for pre- and post-implementation phases respectively (p=0.03). Compared to the existing EMR, information management (data presentation format, efficiency of data access) was reported to be better after AWARE implementation. AWARE made the task of gathering data for rounds significantly less difficult and mentally demanding. CONCLUSIONS The introduction of a novel, patient-centered EMR viewer for the ICU was associated with improved efficiency and ease of clinical data management compared to the standard EMR.

Outcome of Adverse Events and Medical Errors in the Intensive Care Unit: A Systematic Review and Meta-analysis

Adverse events and medical errors (AEs/MEs) are more likely to occur in the intensive care unit (ICU). Information about the incidence and outcomes of such events is conflicting. A systematic review and meta-analysis were conducted to examine the effects of MEs/AEs on mortality and hospital and ICU lengths of stay among ICU patients. Potentially eligible studies were identified from 4 major databases. Of 902 studies screened, 12 met the inclusion criteria, 10 of which are included in the quantitative analysis. Patients with 1 or more MEs/AEs (vs no MEs/AEs) had a nonsignificant increase in mortality (odds ratio = 1.5; 95% confidence interval [CI] = 0.98-2.14) but significantly longer hospital and ICU stays; the mean difference (95% CI) was 8.9 (3.3-14.7) days for hospital stay and 6.8 (0.2-13.4) days for ICU. The ICU environment is associated with a substantial incidence of MEs/AEs, and patients with MEs/AEs have worse outcomes than those with no MEs/AEs.

Education and Knowledge in Pharmacogenomics: Still a Challenge?

A number of barriers exist for adoption of pharmacogenomics into practice. Physicians, pharmacists, and nurses report limited knowledge about pharmacogenomics and its use in patient care. Lack of pharmacogenomics education curricula as part of professional schools or postgraduate training programs has been reported as a potential cause. Understanding pharmacogenomics is further complicated by a complex and nonstandard lexicon, limited medication guidelines, rapidly changing evidence, and insufficient awareness of test availability and utility.

Validation of computerized sniffer for monitoring perioperative normothermia.

INTRODUCTION The World Health Organization sets a standard to maintain patient core temperature greater than 36°C throughout the perioperative period. Normothermia (defined as >36°C) in the Operating Room (OR) is an important factor to preventing complications in patients (MI, infection, coagulopathy). Randomized studies suggests that maintaining at higher temperatures may further reduce complications in surgery (less complications for group at 36.4°C than the control group at 36.0°C) [1,2]. Perioperative normothermia is an important but often unrecognized element during anesthesia. Early recognition of hypothermia would allow for appropriate interventions and prevent complications. METHODOLOGY Manual validation of the diagnostic performance a clinical tool (alert) that would automatically measure changes in core temperature to identify patients who fail to be in range of normothermia during surgery. RESULTS The clinical tool (alert) was found to be 97 % sensitive.

Technical challenges and opportunities when implementing pharmacogenomics decision support integrated in the electronic health record

Clinical use of pharmacogenomic (PGx) knowledge at the bedside is new and complex. Our program has implemented multiple PGx-CDS interventions in different clinical settings and in multiple commercial EHRs. Herein, we discuss lessons learned and propose general technical guidelines related to PGx implementation.