Academic research

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 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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A retrospective study at Leiden University Medical Center aimed to determine the occurrence and duration of hypothermia in infants < 32 weeks gestational age at birth during the first three hours after arrival at their neonatal intensive care unit (NICU) and to identify risk factors. During admission, skin temperature was continuously measured by a skin temperature probe and recorded every minute in MetaVision. The authors found that gestational age at birth and hypothermia at admission were independent risk factors for the occurrence of hypothermia in the first hours during admission and conclude that because hypothermia increases the risks in morbidity and mortality, caregivers should take all precautions to prevent hypothermia, not only in the delivery room, but also in the first hours after admission.

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A study performed at Leiden University Medical Center (LUMC) in the Netherlands studied oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration by comparing two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy. Respiratory support was given by a mechanical ventilator connected to the MetaVision patient data management system (PDMS), which supplied basic patient characteristics as well as clinical parameters every minute. The authors found that training guideline implementation in manual oxygen titration improved SpO2 targeting in preterm infants, with more time spent within the target range and less frequent hyperoxaemia. The durations of hypoxaemia and hyperoxaemia during ABCs (apnoea, bradycardia, cyanosis) were shorter. They conclude that, “This initiative in quality improvement had a positive effect, and if the observed reduction in the risk for hypoxaemia and hyperoxaemia could be maintained through repetitive training, it would be likely to improve the outcome of preterm infants.”

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A retrospective analysis Centre Hospitalier Universitaire Vaudois (CHUV) aimed to analyse the epidemiology, characteristics, and risk factors associated with Staphylococcus aureus early-onset pneumonia (EOP) to identify predictive factors that could be used to target it with early preemptive treatment, such as that using focused antibiotics or specific monoclonal antibodies. Data for all burn patients requiring more than four hours of mechanical ventilation who were admitted between January 2001 and October 2012 were extracted using MetaVision. The authors identified S. aureus carriage as an independent and strong predictor of EOP. They suggest that since rapid point of care testing for S. aureus is readily available, all patients should be tested at admission for burn trauma and early preemptive treatment should be considered for all positive patients, and note that further studies are needed to evaluate this new strategy.

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A systematic review and a meta-analysis of evidence of the impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, LOS, and mortality in ICUs was performed. The authors found that the transition from paper-based ordering to commercial CPOE systems in ICUs was found to be associated with an 85% reduction in medication prescribing error rates. Studies based on MetaVision were included in this review. The authors conclude that, “While limited, the current evidence base suggests that the implementation of commercial CPOE systems can significantly decrease the frequency of medication prescribing error rates, as well as reducing the risk of mortality in ICUs. Future studies that aim to examine medication errors and patient outcomes should ensure they have sufficient sample sizes that are powered to identify the true effect of CPOE implementation. There is also a critical need to understand the nature of errors arising post-CPOE and how the addition of advanced CDSSs can be used to provide even greater benefit to delivering safe and effective patient care.”

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A study performed at Johns Hopkins Hospital evaluated the effect of red blood cell average storage duration on perioperative infectious complications and overall morbidity in patients undergoing radical cystectomy (RC), a high- risk patient population, using clinically relevant definitions of older blood. We hypothesise perioperative blood transfusion with blood stored for longer average duration are associated with higher rates of perioperative infection and morbidity in patients undergoing RC. Patients who underwent RC for bladder cancer at Johns Hopkins Hospital between January 2010 and December 2014 were analysed using data from MetaVision, among other systems. The authors found that although blood is stored up to 42 days, storage of 28 days or more may expose RC patients to increased perioperative infections and overall morbidity compared with storage of less than 28 days. They suggest that prospective cohort studies are performed in cystectomy and other high-risk surgical oncology patients to better determine the effect of blood storage duration.

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A study performed at University Hospital of Antwerp aimed to develop new quantitative features for the Perfusion Index signal recorded continuously over the first 24 hours of life in a cohort of extremely low gestational age newborns and to assess the association of these features with normal and adverse short-term outcome. The authors conclude that low values and reduced short-term variability of Perfusion Index on day 1 are associated with adverse outcomes. These results contribute to the current understanding of preterm circulatory adaptation and suggest that the Perfusion Index could become a monitoring tool for peripheral perfusion in extremely preterm infants. MetaVision was used to digitally store Perfusion Index values.

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