Academic research

A prospective observational cohort study performed at Barnes Jewish Hospital compared the change in a validated quality of life measure (VR-12) after elective surgery, to a global assessment measure. It also estimated the minimum clinically important difference (MCID) for change in VR-12 quality of life and aimed to describe this change by surgical specialty. Surgical specialty and all other variables were obtained from MetaVision. The results showed the two methods of quality of life assessment to be in poor agreement. The study authors conclude that clinicians should select an instrument based on their goals, using 2.5 points as the MCID for the VR-12. They propose that future studies should confirm the difference in quality of life changes across surgical specialties and explore the reasons for such differences.

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A Quality Improvement study performed at Academic Medical Center in The Netherlands investigated whether a stroke volume guided goal-directed therapy (GDT) improves the postoperative outcome of patients undergoing oesophageal surgery. The authors initiated a quality improvement program that used GDT as a new standard of care for all patients undergoing oesophagectomy at their institution. Patients’ characteristics, surgical outcome and oncologic results were prospectively collected from the MetaVision Patient Data Management System (PDMS). The authors found that the implementation of GDT during oesophagectomy did not reduce overall morbidity, mortality and hospital length of stay but pneumonia, mediastinal abscesses, the proportion of patients staying more than 48 hours in the ICU and fluid balance were lower in the GDT group. In light of this finding, they suggest that larger (randomised) studies are necessary to reveal possible benefits with a higher reliability, and point out that the economic impact of GDT remains to be determined.

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An observational cohort study performed in the Netherlands explored the effect of ketanserin, a 5-HT2 receptor-blocking agent, on increased delta temperature (deltaT). It aimed to determine whether the suggested clinical effect on peripheral temperature (a measurement of microcirculation) of a continuous infusion of ketanserin occurs in clinical practice. All data were prospectively measured and stored in MetaVision. The authors conclude that, “…we have shown that ketanserin is able to improve peripheral temperature in critically ill patients without increasing the need for fluids or vasopressors. Whether this effect is of clinical importance should be studied in future studies.”

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A study performed at Johns Hopkins Hospital aimed to characterise the relationship between blood transfusion and different types of morbidity after posterior spine fusion by retrospectively analysing electronic medical records. The purpose of the study was to determine both if perioperative red blood cell (RBC) transfusion is associated with postoperative morbidity (including non-infectious complications) and if a dose-response relationship exists between transfusion and the likelihood of developing these complications. MetaVision was one of the systems that provided the necessary data for the study. To the authors’ knowledge, this is the first study to investigate non-infectious outcomes after spine fusion, and the relationship between transfusion and these complications. The data demonstrates risk-adjusted and transfusion dose-related increases in perioperative morbidity, with thrombotic and infectious events being the most common. The authors conclude that their findings offer new insights into the risk-benefit balance between anaemia, transfusion, and outcomes, and may help inform clinical decision-making, stating “By identifying transfusion as a risk factor for thrombosis and infections, our results may serve to heighten clinician awareness to optimise prevention, diagnosis, and treatment of these complications and thereby improve outcomes after spinal fusion.”

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A multicenter, population-based cohort study of consecutive apnoea tests was performed in urban centers in the province of Alberta in order to compare the conventional oxygen (O2) insufflation catheter method with use of a resuscitation bag with continuous positive airway pressure (CPAP) valve. The MetaVision clinical information system, which is used in ICUs across the province of Alberta, was used to identify consecutive apnoea tests that were performed in Calgary since introduction of the clinical information system in 2012-2013, and in Edmonton since mid-2014. The results showed that apnoea testing can be safely performed with both methods assessed in the study, including the O2 catheter technique recommended in major guideline documents. In contrast with some previous research, this study could not confirm the superiority of apnoea testing using a CPAP valve. The authors come to the following conclusions: “We believe that clinicians should perform regular arterial blood gases (ABGs) at fixed intervals of 3–5 min in order to avoid severe respiratory acidosis, and terminate the apnoea test as soon as accepted criteria for brain death are met to help avoid significant hemodynamic complications. If the O2 catheter method is used, limiting flow rate to no more than 6–8 L/min may minimise the risk of pneumothorax and avoid any carbon dioxide (CO2) elimination that could conceivably slow the rise of arterial partial pressure of carbon dioxide (PCO2) in some patients.”

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A prospective cohort audit performed at Alberta Health Services aimed to identify compliance and reasons for noncompliance to a nurse-driven feeding protocol at a tertiary care hospital PICU in Canada, with a secondary aim of determining the mean time (hours) spent without any form of nutrition and to identify reasons for interruptions to nutrition support. To the authors’ knowledge, this study is the first to examine reasons for noncompliance to a feeding protocol in the PICU. Data points were collected with a combination of paper charts and MetaVision. The authors found that there was a 95% compliance rate to the protocol and an average of 25.6 hours spent without nutrition per patient, and that the most prevalent reason for noncompliance was an avoidable delay in restarting feeds before/after procedures or after surgery. They conclude that, “A nurse-driven feeding protocol may reduce time spent without nutrition. Future research is required to examine the relationship between adherence to feeding protocols and clinical outcomes.”

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A study performed in the NICU at Leiden University Medical Centre compared the effectiveness of an automated fraction of inspired oxygen (FiO2) system with manual titration of FiO2 in maintaining oxygen saturation (SpO2) within the intended target range. This is the first study that examines the impact of having automated FiO2 implemented in routine care for longer periods of time. The characteristics of each infant as well as clinical parameters and ventilator settings (including the FiO2 and SpO2) were sampled every minute and routinely collected in MetaVision. The authors conclude that implementation of automated FiO2 control led to an increased compliance of maintaining SpO2 within the intended target range during oxygen therapy, with the study results showing a significant decrease in hyperoxaemia, although no effect on hypoxaemia. The authors suggest that additional randomised studies be performed to confirm the beneficial effects of such automated oxygen control on the outcome for preterm infants.

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A study investigated and compared usability across eight different computerised critical care information systems (CCIS) currently used in Germany. German intensive care unit (ICU) nurses and physicians completed a specialised, previously validated, web-based questionnaire which assessed CCIS usability based on three rating models: an overall rating of the systems, a model rating technical usability, and a model rating task-specific usability. This is the first study to compare how clinical users rate the usability of CCIS currently in clinical use and to perform an in-depth analysis of the underlying conditions determining high/low CCIS usability. MetaVision was one of the three systems that received the highest marks in overall ratings as well as in ratings of technical usability (i.e., the ease-of-use or user-friendliness of the system), and task-specific usability (i.e., the utility of the system or functions/features that a program offers to support specific clinical tasks). The authors conclude that, “Regardless of the program used, our results show that the overall rating of a CCIS is more dependent on the program’s ease-of-use than the actual scope of the features that a program has to offer. Furthermore, for most systems, the general scope of the functions offered is rated better than how well the functions are realized. This suggests that the time has come for manufacturers to shift some of their effort away from the development of new features and focus increasingly on improving the user-friendliness and quality of existing features.”

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