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Is the Implementation of an Interprofessional Communication Smart Phone Application Associated With Improved Survival Among Critically Ill Surgical Patients?

      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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      References

        • Guidelines for Intensive Care Unit Admission, Discharge, and Triage
        Task force of the American College of critical care medicine, society of critical care medicine.
        Crit Care Med. 1999; 27: 633-638
        • Halpern N.A.
        • Pastores S.M.
        Critical care medicine beds, use, occupancy, and costs in the United States: a methodological Review.
        Crit Care Med. 2015; 43: 2452-2459
        • Hall M.J.
        • Levant S.
        • DeFrances C.J.
        Trends in inpatient hospital deaths: national hospital discharge survey, 2000-2010.
        NCHS Data Brief. 2013; 118: 1-8
        • Pronovost P.J.
        • Thompson D.A.
        • Holzmueller C.G.
        • et al.
        Toward learning from patient safety reporting systems.
        J Crit Care. 2006; 21: 305-315
        • Zimmerman J.E.
        • Kramer A.A.
        • Knaus W.A.
        Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012.
        Crit Care. 2013; 17: R81
        • Checkley W.
        • Martin G.S.
        • Brown S.M.
        • et al.
        Structure, process, and annual ICU mortality across 69 centers: United States critical illness and injury trials group critical illness outcomes study.
        Crit Care Med. 2014; 42: 344-356
        • Davenport D.L.
        • Henderson W.G.
        • Mosca C.L.
        • Khuri S.F.
        • Mentzer R.M.
        Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions.
        J Am Coll Surg. 2007; 205: 778-784
        • Malone D.L.
        • Genuit T.
        • Tracy J.K.
        • Gannon C.
        • Napolitano L.M.
        Surgical site infections: reanalysis of risk factors.
        J Surg Res. 2002; 103: 89-95
        • Pham H.
        • Russell T.
        • Seiwert A.
        • Kasper G.
        • Lurie F.
        Timing of hospital-acquired venous thromboembolism and its relationship with venous thromboembolism prevention measures in immobile patients.
        Ann Vasc Surg. 2019; 56: 24-28
        • Hendren S.
        • Fritze D.
        • Banerjee M.
        • et al.
        Antibiotic choice is independently associated with risk of surgical site infection after colectomy: a population-based cohort study.
        Ann Surg. 2013; 257: 469-475
        • Arora N.
        • Patel K.
        • Engell C.A.
        • LaRosa J.A.
        The effect of interdisciplinary team rounds on urinary catheter and central venous catheter days and rates of infection.
        Am J Med Qual. 2014; 29: 329-334
        • Writing Group for the CHECKLIST-ICU Investigators and the Brazilian Research in Intensive Care Network (BRICNet)
        Effect of a quality improvement intervention with daily round checklists, goal setting, and clinician prompting on mortality of critically ill patients: a randomized clinical trial.
        JAMA. 2016; 315: 1480-1490
        • Pronovost P.
        • Needham D.
        • Berenholtz S.
        • et al.
        An intervention to decrease catheter-related bloodstream infections in the ICU.
        N Engl J Med. 2006; 355: 2725-2732
        • Fackler J.C.
        • Watts C.
        • Grome A.
        • Miller T.
        • Crandall B.
        • Pronovost P.
        Critical care physician cognitive task analysis: an exploratory study.
        Crit Care. 2009; 13: R33
        • Alvarez G.
        • Coiera E.
        Interdisciplinary communication: an uncharted source of medical error?.
        J Crit Care. 2006; 21 (discussion 242): 236-242
        • Breslin S.
        • Greskovich W.
        • Turisco F.
        Wireless technology improves nursing workflow and communications.
        Comput Inform Nurs. 2004; 22: 275-281
        • Pemmasani V.
        • Paget T.
        • van Woerden H.C.
        • Minamareddy P.
        • Pemmasani S.
        Hands-free communication to free up nursing time.
        Nurs Times. 2014; 110: 12-14
        • Vandenkerkhof E.G.
        • Hall S.
        • Wilson R.
        • Gay A.
        • Duhn L.
        Evaluation of an innovative communication technology in an acute care setting.
        Comput Inform Nurs. 2009; 27: 254-262
        • Ernst A.A.
        • Weiss S.J.
        • Reitsema J.A.
        Does the addition of Vocera hands-free communication device improve interruptions in an academic emergency department?.
        South Med J. 2013; 106: 189-195
        • Goebel M.
        • Bledsoe J.
        Push notifications reduce emergency department response times to prehospital ST-segment elevation myocardial infarction.
        West J Emerg Med. 2019; 20: 212-218
        • Zhou H.
        • Taber C.
        • Arcona S.
        • Li Y.
        Difference-in-Differences method in comparative effectiveness research: utility with unbalanced groups.
        Appl Health Econ Health Policy. 2016; 14: 419-429
        • Crown W.H.
        Propensity-score matching in economic analyses: comparison with regression models, instrumental variables, residual inclusion, differences-in-differences, and decomposition methods.
        Appl Health Econ Health Policy. 2014; 12: 7-18
        • Abadie A.
        Semiparametric difference-in-differences estimators.
        Rev Econ Stud. 2005; 72: 1-19
        • Burke L.G.
        • Frakt A.B.
        • Khullar D.
        • Orav E.J.
        • Jha A.K.
        Association between teaching status and mortality in US hospitals.
        JAMA. 2017; 317: 2105-2113