Abstract
Introduction
Patients admitted to intensive care units (ICUs) have high rates of mortality and
morbidity. Improved communication between providers within ICUs may reduce morbidity.
The goal of this study is to leverage a natural experiment of the temporally staggered
implementation of a smart phone application for interprofessional communication to
quantify the association with postoperative mortality and morbidity among critically
ill surgical patients.
Methods
We conducted an observational case-control study and utilized a difference-in-difference
model to determine the impact of temporally staggered implementation of an interprofessional
communication smart phone application on mortality, postoperative hyperglycemia, malnutrition,
venous thromboembolism (VTE), and surgical site infections. Our study included patients
who underwent surgical procedures and were admitted to the ICU at one of three hospitals
(one academic medical center, hospital A, and two community hospitals, hospitals B
and C) in a single health system between March 2018 and April 2021.
Results
Our cohort consisted of 1457 patients, of which 1174 were hospitalized at hospital
A and 283 at hospitals B and C. In the full cohort, 80 (5.6%) patients died during
ICU admission. Difference-in-difference analysis demonstrated a relative difference
in mortality of 4.8% [1.1%-8.5%] (P = 0.04) at hospitals B and C compared to hospital A after the implementation of the
application. Our model demonstrated a 2.5% difference in VTEs [1.1%-3.8%], P = 0.03. There were no significant reductions in hyperglycemia, malnutrition, or surgical
site infection.
Conclusions
The implementation of an interprofessional communication smart phone application is
associated with reduced mortality and VTE incidence among critically ill surgical
patients across three diverse hospitals.
Keywords
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Article info
Publication history
Accepted:
October 16,
2022
Received in revised form:
September 15,
2022
Received:
April 27,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
