Evaluating a novel, integrative dashboard for health professionals performance in managing deteriorating patients: quality improvement project

BackgroundThe quality of recording and documentation of deteriorating patient management by health professionals has been challenged at health system level during the COVID-19 pandemic. Non-adherence to monitoring and escalation guidelines and poor documentation increases risk of serious adverse events. Electronic health record (EHR)-integrated dashboards are real-time auditing tools of patients status and clinicians performance, but neither the views nor the performance of health professionals have been assessed, relating to management of deteriorating patients.. ObjectiveTo develop and evaluate a real-time dashboard of deteriorating patients assessment, referral, and therapy by examining the perception of the dashboard and the performance of nurses and physicians. SettingsFive academic hospitals in the largest NHS trust in the UK (Barts Health NHS Trust). InterventionThe dashboard was developed from EHR data to investigate patients with NEWS2>5, assessment, and escalation of deteriorating patients. We adopted the Plan, Do, Study, Act model and followed the SQUIRE framework to evaluate the dashboard. DesignMixed methods: (i) Virtual, face-to-face, key informant interviews and (ii) Retrospective descriptive EHR data analysis to measure performance change over time. ResultsWe interviewed 3 nurses (2 quality and safety and 1 informatics specialists). Key themes were: (1) participants perceived the dashboard as a facilitator for auditing NEWS2 recording and escalation of care to improve clinicians practice; (2) There is a need for guiding clinicians and adjusting data sources and metrics which could enhance the functionality and usability. From EHR (2019 to 2022) data analysis showed: (1) NEWS2 recording has gradually improved in the implementation and evaluation phases (May 2021 to Apr 2022) from 64% to 83%; (2) Referral and nurses assessment forms completion increased (n: 170 to 6800 & 23 to 540, respectively). ConclusionThe deterioration dashboard is an effective real time data-driven method for improving the quality of managing deteriorating patients. Improving the dashboard by integrating multiple health systems, a wider analysis of further NEWS2 and escalation of care metrics, clinicians learning of digital solutions will enhance functionality and experience, potentially boosting its value. There is a need to examine the generalizability of the dashboard through further validation and quality improvement studies.