The technology integrates data from a patient’s electronic health record (EHR) and medical devices in his or her room and analyzes the data against checklists to help prevent ventilator-associated events, delirium, ICU-acquired weakness, central-line associated blood stream infections, and venous thromboembolism. The app also assesses whether patients’ goals and physicians’ understanding of those goals are aligned, and whether patients experience a loss of dignity and respect in the care they receive.
A “harms monitor” in the shape of a clock dial turns red in areas that need attention, turns green in the areas where all preventive therapies are complete and “in parameter,” and turns gray in any area where that risk does not apply to a patient’s care (e.g., for non-ventilated patients, the ventilator-associated events section will gray out).
Funded by the Gordon and Betty Moore Foundation, which also helped to sponsor a recent NQF initiative on the role of data for systematic improvement in healthcare, the Johns Hopkins project is still in its early stages. But Cindy Dwyer, the senior nurse coordinating the pilot program in the Johns Hopkins Hospital’s surgical ICU, says that the app has already made a difference in patient care.
“As a unit, we have seen this whole project really, really change our mobility process for the ICU,” Dwyer said. “We didn’t have a culture of getting our patients up out of bed.” Because the app assesses a lack of mobility as a risk for ICU-acquired weakness, clinicians assess patients’ mobility daily and incorporate getting out of bed, when the patient is able, into daily care plans.
The app is fundamentally changing the patient experience in the ICU by encouraging more intimate communication between patients and clinicians. Patients and/or family members can detail their health care goals while in the ICU. If a clinician's understanding of a patient’s goals don't match, the app considers that a harm, prompting dialogue that previously may not have occurred as early in a patient’s stay between clinicians, patients, and families. The app also encourages patients and families to share personal details with the care team, from pictures and hobbies to answers to questions such as: What do you fear the most about the ICU? and What gives you strength?
Another unique aspect of the app—dubbed “Project Emerge”—is the approach to its development: The Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine teamed up with the Johns Hopkins University’s Applied Physics Laboratory and gathered input from a broad range of academic disciplines and clinicians. Peter Pronovost, MD, PhD, director of the Armstrong Institute, explained the reasoning behind this process.
“Healthcare has spent significantly on information technology but productivity has been negative and safety has barely improved,” he said. “We need a systems engineering approach.”
Development of the app and its integration into the Johns Hopkins EHR system took two years. The surgical ICU began piloting the app in June 2014 and testing it with real-time EHR data in 2015. The app was recently implemented in an ICU at the University of California-San Francisco Medical Center. The Project Emerge team plans to implement the technology in additional ICUs and hospitals around the world, through a new collaboration with Microsoft.
This article is part of a series of stories on NQF’s website that look at innovations to capture data and use measurement to improve healthcare.