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A Novel Electronic Rounding Tool to Assist in ICU Fellow Training in Quality

Brown University
Providence, RI

Program Director: Nicholas Ward, MD
Type of Program: Pulmonary and Critical Care Medicine
Abstract Authors: Gerardo P. Carino, MD; Abdullah Chahin, MD; Sameer Shah, MD; Dawn Menard, MD; Jason Aliotta, MD; and Andrew Levinson, MD

Checklists and daily goal sheets have been widely shown to improve the quality of critical care. A daily paper “Rounding Tool” had been used in the Miriam Hospital and Rhode Island Hospital ICUs. This rounding tool was useful as a reminder to the ICU team to address important issues, including daily weaning, review of the necessity for central lines and Foley catheters, glucose control, and DVT prophylaxis. However, these daily goals sheets proved to be an inefficient way of organizing, interpreting, and utilizing the data that was collected. By the time data was tabulated and organized, many months had passed.

In order to improve ongoing real-time feedback, we developed a wireless tablet-based ICU Quality Data collection tool using Adobe Acrobat XI that we now routinely use on ICU rounds. As part of the electronic system, the ICU fellows are responsible for the eRounding Tool each day and the quality data collected is automatically saved for review and analysis in Microsoft Excel. Weekly, this data is shared with the ICU fellows as feedback regarding the quality of care delivered during their ICU rotation. This program was initiated on March 1, 2015. Our ICU also maintains an ongoing “ICU Quality Dashboard,” which is reviewed monthly at the ICU Quality Meetings. The dashboard includes information about the rates of hospital-acquired infections (e.g., nosocomial C. difficile infections, catheter-associated UTIs, catheter-related bloodstream infections), patient falls, ventilator-associated pneumonia, hospital-acquired pressure ulcers, and other quality measures important to the ICU and the institution.

The goal of this project is to compare data collected using our eRounding Tool with monthly ICU quality data. The fellows have access to data regarding their specific performance in the ICU and how it directly affects patient outcomes. We have already seen improvements in important indicators with the eRounding Tool. For example, for the first 2 months of implementation, our rates of Foley utilization in one of our ICUs decreased 30 percent from the previous full year. We feel that this eRounding Tool is an important and potentially powerful innovation developed by our fellowship program. Fellows learn a great deal about quality of care in the ICU and positively affect the care they provide, while meeting current ACGME requirements regarding involvement in quality improvement. Individual programs could easily construct their own eRounding Tool to address important issues unique to their own hospital and training program.