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Article ; Online: Who needs clinician attention first? A qualitative study of critical care clinicians' needs that enable the prioritization of care for populations of acutely ill patients.

Herasevich, Svetlana / Pinevich, Yuliya / Lindroth, Heidi L / Herasevich, Vitaly / Pickering, Brian W / Barwise, Amelia K

International journal of medical informatics

2023 Volume 177, Page(s) 105118

Abstract: Background: To adequately care for groups of acutely ill patients, clinicians maintain situational awareness to identify the most acute needs within the entire intensive care unit (ICU) population through constant reappraisal of patient data from ... ...

Abstract	Background: To adequately care for groups of acutely ill patients, clinicians maintain situational awareness to identify the most acute needs within the entire intensive care unit (ICU) population through constant reappraisal of patient data from electronic medical record and other information sources. Our objective was to understand the information and process requirements of clinicians caring for multiple ICU patients and how this information is used to support their prioritization of care among populations of acutely ill patients. Additionally, we wanted to gather insights on the organization of an Acute care multi-patient viewer (AMP) dashboard. Methods: We conducted and audio-recorded semi-structured interviews of ICU clinicians who had worked with the AMP in three quaternary care hospitals. The transcripts were analyzed with open, axial, and selective coding. Data was managed using NVivo 12 software. Results: We interviewed 20 clinicians and identified 5 main themes following data analysis: (1) strategies used to enable patient prioritization, (2) strategies used for optimizing task organization, (3) information and factors helpful for situational awareness within the ICU, (4) unrecognized or missed critical events and information, and (5) suggestions for AMP organization and content. Prioritization of critical care was largely determined by severity of illness and trajectory of patient clinical status. Important sources of information were communication with colleagues from the previous shift, bedside nurses, and patients, data from the electronic medical record and AMP, and physical presence and availability in the ICU. Conclusions: This qualitative study explored ICU clinicians' information and process requirements to enable the prioritization of care among populations of acutely ill patients. Timely recognition of patients who need priority attention and intervention provides opportunities for improvement of critical care and for preventing catastrophic events in the ICU.
MeSH term(s)	Humans ; Critical Care ; Intensive Care Units ; Qualitative Research ; Communication ; Attention
Language	English
Publishing date	2023-06-02
Publishing country	Ireland
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1466296-6
ISSN	1872-8243 ; 1386-5056
ISSN (online)	1872-8243
ISSN	1386-5056
DOI	10.1016/j.ijmedinf.2023.105118
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Article ; Online: Information and Data Visualization Needs among Direct Care Nurses in the Intensive Care Unit.

Lindroth, Heidi L / Pinevich, Yuliya / Barwise, Amelia K / Fathma, Sawsan / Diedrich, Daniel / Pickering, Brian W / Herasevich, Vitaly

Applied clinical informatics

2022 Volume 13, Issue 5, Page(s) 1207–1213

Abstract: Objectives: Intensive care unit (ICU) direct care nurses spend 22% of their shift completing tasks within the electronic health record (EHR). Miscommunications and inefficiencies occur, particularly during patient hand-off, placing patient safety at ... ...

Abstract	Objectives: Intensive care unit (ICU) direct care nurses spend 22% of their shift completing tasks within the electronic health record (EHR). Miscommunications and inefficiencies occur, particularly during patient hand-off, placing patient safety at risk. Redesigning how direct care nurses visualize and interact with patient information during hand-off is one opportunity to improve EHR use. A web-based survey was deployed to better understand the information and visualization needs at patient hand-off to inform redesign. Methods: A multicenter anonymous web-based survey of direct care ICU nurses was conducted (9-12/2021). Semi-structured interviews with stakeholders informed survey development. The primary outcome was identifying primary EHR data needs at patient hand-off for inclusion in future EHR visualization and interface development. Secondary outcomes included current use of the EHR at patient hand-off, EHR satisfaction, and visualization preferences. Frequencies, means, and medians were calculated for each data item then ranked in descending order to generate proportional quarters using SAS v9.4. Results: In total, 107 direct care ICU nurses completed the survey. The majority (46%, Conclusion: We identified information and visualization needs of direct care ICU nurses. The study findings could serve as a baseline toward redesigning an EHR interface.
MeSH term(s)	Humans ; Data Visualization ; Intensive Care Units ; Surveys and Questionnaires ; Electronic Health Records ; Nurses
Language	English
Publishing date	2022-12-28
Publishing country	Germany
Document type	Multicenter Study ; Journal Article
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0042-1758735
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Article ; Online: The authors reply.

Herasevich, Svetlana / Lindroth, Heidi L / Pinevich, Yuliya / Lipatov, Kirill / Tekin, Aysun / Herasevich, Vitaly / Pickering, Brian W / Barwise, Amelia K

Critical care medicine

2022 Volume 50, Issue 11, Page(s) e804–e805

Language	English
Publishing date	2022-10-13
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000005664
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Article ; Online: Evaluation of Digital Health Strategy to Support Clinician-Led Critically Ill Patient Population Management: A Randomized Crossover Study.

Herasevich, Svetlana / Pinevich, Yuliya / Lipatov, Kirill / Barwise, Amelia K / Lindroth, Heidi L / LeMahieu, Allison M / Dong, Yue / Herasevich, Vitaly / Pickering, Brian W

Critical care explorations

2023 Volume 5, Issue 5, Page(s) e0909

Abstract: To investigate whether a novel acute care multipatient viewer (AMP), created with an understanding of clinician information and process requirements, could reduce time to clinical decision-making among clinicians caring for populations of acutely ill ... ...

Abstract	To investigate whether a novel acute care multipatient viewer (AMP), created with an understanding of clinician information and process requirements, could reduce time to clinical decision-making among clinicians caring for populations of acutely ill patients compared with a widely used commercial electronic medical record (EMR). Design: Single center randomized crossover study. Setting: Quaternary care academic hospital. Subjects: Attending and in-training critical care physicians, and advanced practice providers. Interventions: AMP. Measurements and main results: We compared ICU clinician performance in structured clinical task completion using two electronic environments-the standard commercial EMR (Epic) versus the novel AMP in addition to Epic. Twenty subjects (10 pairs of clinicians) participated in the study. During the study session, each participant completed the tasks on two ICUs (7-10 beds each) and eight individual patients. The adjusted time for assessment of the entire ICU and the adjusted total time to task completion were significantly lower using AMP versus standard commercial EMR (-6.11; 95% CI, -7.91 to -4.30 min and -5.38; 95% CI, -7.56 to -3.20 min, respectively; Conclusions: When compared with the standard EMR, AMP significantly reduced time to assessment of an entire ICU, total time to clinical task completion, and clinician task load. Additional research is needed to assess the clinicians' performance while using AMP in the live ICU setting.
Language	English
Publishing date	2023-05-03
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000909
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Article ; Online: Association of delirium with increased short-term mortality among older emergency department patients: A cohort study.

Arneson, Mariah L / Oliveira J E Silva, Lucas / Stanich, Jessica A / Jeffery, Molly M / Lindroth, Heidi L / Ginsburg, Alexander D / Bower, Susan M / Mullan, Aidan F / Bellolio, Fernanda

The American journal of emergency medicine

2023 Volume 66, Page(s) 105–110

Abstract: Study objective: To evaluate the association between delirium and subsequent short-term mortality in geriatric patients presenting to the emergency department (ED).: Methods: This was an observational cohort study of adults age ≥75 years who ... ...

Abstract	Study objective: To evaluate the association between delirium and subsequent short-term mortality in geriatric patients presenting to the emergency department (ED). Methods: This was an observational cohort study of adults age ≥75 years who presented to an academic ED and were screened for delirium during their ED visit. The Delirium Triage Screen followed by the Brief Confusion Assessment Method were used to ascertain the presence of delirium. In-hospital, 7-day, and 30-day mortality were compared between patients with and without ED delirium. Odds ratios with 95% confidence intervals (CIs) were calculated through logistic regression after adjusting for confounders including age, sex, history of dementia, ED disposition, and acuity. Results: A total of 967 ED visits were included for analysis among which delirium was detected in 107 (11.1%). The median age of the cohort was 83 years (IQR 79, 88), 526 (54.4%) were female, 285 (29.5%) had documented dementia, and 171 (17.7%) had a high acuity Emergency Severity Index triage level 1 or 2. During the hospitalization, 5/107 (4.7%) of those with delirium and 4/860 (0.5%) of those without delirium died. Within 7 days of ED departure, 6/107 (5.6%) of those with delirium and 6/860 (0.7%) of those without delirium died (unadjusted OR 8.46, 95% CI 2.68-26.71). Within 30 days, 18/107 (16.8%) of those with delirium and 37/860 (4.3%) of those without delirium died (unadjusted OR 4.50, 95% CI 2.46-8.23). ED delirium remained associated with higher 7-day (adjusted OR 5.23, 95% CI 1.44-19.05, p = 0.008) and 30-day mortality (adjusted OR 2.82, 95% CI 1.45-5.46, p = 0.002). Conclusion: Delirium is an important prognostic factor that ED clinicians and nurses must be aware of to optimize delirium prevention, management, disposition, and communication with patients and families.
MeSH term(s)	Humans ; Female ; Aged ; Male ; Cohort Studies ; Delirium/epidemiology ; Prospective Studies ; Emergency Service, Hospital ; Dementia/complications
Language	English
Publishing date	2023-01-26
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2023.01.040
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Article: Information and Data Visualization Needs among Direct Care Nurses in the Intensive Care Unit

Lindroth, Heidi L. / Pinevich, Yuliya / Barwise, Amelia K. / Fathma, Sawsan / Diedrich, Daniel / Pickering, Brian W. / Herasevich, Vitaly

Applied Clinical Informatics

2022 Volume 13, Issue 05, Page(s) 1207–1213

Abstract	Objectives: Intensive care unit (ICU) direct care nurses spend 22% of their shift completing tasks within the electronic health record (EHR). Miscommunications and inefficiencies occur, particularly during patient hand-off, placing patient safety at risk. Redesigning how direct care nurses visualize and interact with patient information during hand-off is one opportunity to improve EHR use. A web-based survey was deployed to better understand the information and visualization needs at patient hand-off to inform redesign. Methods: A multicenter anonymous web-based survey of direct care ICU nurses was conducted (9–12/2021). Semi-structured interviews with stakeholders informed survey development. The primary outcome was identifying primary EHR data needs at patient hand-off for inclusion in future EHR visualization and interface development. Secondary outcomes included current use of the EHR at patient hand-off, EHR satisfaction, and visualization preferences. Frequencies, means, and medians were calculated for each data item then ranked in descending order to generate proportional quarters using SAS v9.4. Results: In total, 107 direct care ICU nurses completed the survey. The majority (46%, n = 49/107) use the EHR at patient hand-off to verify exchanged verbal information. Sixty-four percent ( n = 68/107) indicated that current EHR visualization was insufficient. At the start of an ICU shift, primary EHR data needs included hemodynamics (mean 4.89 ± 0.37, 98%, n = 105), continuous IV medications (4.55 ± 0.73, 93%, n = 99), laboratory results (4.60 ± 0.56, 96%, n = 103), mechanical circulatory support devices (4.62 ± 0.72, 90%, n = 97), code status (4.40 ± 0.85, 59%, n = 108), and ventilation status (4.35 + 0.79, 51%, n = 108). Secondary outcomes included mean EHR satisfaction of 65 (0–100 scale, standard deviation = ± 21) and preferred future EHR user-interfaces to be organized by organ system (53%, n = 57/107) and visualized by tasks/schedule (61%, n = 65/107). Conclusion: We identified information and visualization needs of direct care ICU nurses. The study findings could serve as a baseline toward redesigning an EHR interface.
Keywords	data visualization ; intensive care unit ; nurse ; electronic health record
Language	English
Publishing date	2022-10-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0042-1758735
Database	Thieme publisher's database

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Article ; Online: Delirium severity does not differ between medical and surgical intensive care units after adjusting for medication use.

Ortiz, Damaris / Lindroth, Heidi L / Braly, Tyler / Perkins, Anthony J / Mohanty, Sanjay / Meagher, Ashley D / Khan, Sikandar H / Boustani, Malaz A / Khan, Babar A

Scientific reports

2022 Volume 12, Issue 1, Page(s) 14447

Abstract: Severe delirium is associated with an increased risk of mortality, institutionalization, and length of stay. Few studies have examined differences in delirium severity between different populations of critically ill patients. The objective of the study ... ...

Abstract	Severe delirium is associated with an increased risk of mortality, institutionalization, and length of stay. Few studies have examined differences in delirium severity between different populations of critically ill patients. The objective of the study was to compare delirium severity and the presence of the four core features between adults in the surgical intensive care unit (SICU) and medical intensive care unit (MICU) while controlling for variables known to be associated with delirium. This is a secondary analysis of two parallel randomized multi-center trials conducted from March 2009 to January 2015 at 3 Indianapolis hospitals. A total of 474 adults with delirium were included in the analysis. Subjects were randomized in a 1:1 ratio in random blocks of 4 by a computer program. Patients were randomized to either haloperidol prescribing or de-prescribing regimen vs usual care. Delirium severity was assessed daily or twice-daily using the CAM-ICU-7 beginning after 24 h of ICU admission and until discharge from the hospital, death, or 30 days after enrollment. Secondary outcomes included hospital length of stay, hospital and 30-day mortality, and delirium-related adverse events. These outcomes were compared between SICU and MICU settings for this secondary analysis. Out of 474 patients, 237 were randomized to intervention. At study enrollment, the overall cohort had a mean age of 59 (SD 16) years old, was 54% female, 44% African-American, and 81% were mechanically ventilated upon enrollment. MICU participants were significantly older and severely ill with a higher premorbid cognitive and physical dysfunction burden. In univariate analysis, SICU participants had significantly higher mean total CAM-ICU-7 scores, corresponding to delirium severity, (4.15 (2.20) vs 3.60 (2.32), p = 0.02), and a lower mean RASS score (- 1.79 (1.28) vs - 1.53 (1.27), p < 0.001) compared to MICU participants. Following adjustment for benzodiazepines and opioids, delirium severity did not significantly differ between groups. The presence of Feature 3, altered level of consciousness, was significantly associated with the SICU participants, identifying as Black, premorbid functional impairment, benzodiazepines, opioids, and dexmedetomidine. In this secondary analysis examining differences in delirium severity between MICU and SICU participants, we did not identify a difference between participant populations following adjustment for administered benzodiazepines and opioids. We did identify that an altered level of consciousness, core feature 3 of delirium, was associated with SICU setting, identifying as Black, activities of daily living, benzodiazepines and opioid medications. These results suggest that sedation practice patterns play a bigger role in delirium severity than the underlying physiologic insult, and expression of core features of delirium may vary based on individual factors.Trial registration CT#: NCT00842608.
MeSH term(s)	Activities of Daily Living ; Adolescent ; Adult ; Analgesics, Opioid/therapeutic use ; Benzodiazepines/therapeutic use ; Consciousness Disorders/complications ; Critical Care ; Delirium/drug therapy ; Delirium/etiology ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged
Chemical Substances	Analgesics, Opioid ; Benzodiazepines (12794-10-4)
Language	English
Publishing date	2022-08-24
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-18429-9
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Article ; Online: Association between emergency department modifiable risk factors and subsequent delirium among hospitalized older adults.

Oliveira J E Silva, Lucas / Stanich, Jessica A / Jeffery, Molly M / Lindroth, Heidi L / Miller, Donna M / Campbell, Ronna L / Rabinstein, Alejandro A / Pignolo, Robert J / Bellolio, Fernanda

The American journal of emergency medicine

2021 Volume 53, Page(s) 201–207

Abstract: Study objective: To evaluate the association between potential emergency department (ED)-based modifiable risk factors and subsequent development of delirium among hospitalized older adults free of delirium at the time of ED stay.: Methods: ... ...

Abstract	Study objective: To evaluate the association between potential emergency department (ED)-based modifiable risk factors and subsequent development of delirium among hospitalized older adults free of delirium at the time of ED stay. Methods: Observational cohort study of patients aged ≥75 years who screened negative for delirium in the ED, were subsequently admitted to the hospital, and had delirium screening performed within 48 h of admission. Potential ED-based risk factors for delirium included ED length of stay (LOS), administration of opioids, benzodiazepines, antipsychotics, or anticholinergics, and the placement of urinary catheter while in the ED. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CIs) were calculated. Results: Among 472 patients without delirium in the ED (mean age 84 years, 54.2% females), 33 (7.0%) patients developed delirium within 48 h of hospitalization. The ED LOS of those who developed delirium was similar to those who did not develop delirium (312.1 vs 325.6 min, MD -13.5 min, CI -56.1 to 29.0). Patients who received opioids in the ED were as likely to develop delirium as those who did not receive opioids (7.2% vs 6.9%: OR 1.04, CI 0.44 to 2.48). Patients who received benzodiazepines had a higher risk of incident delirium, the difference was clinically but not statistically significant (37.3% vs 6.5%, OR 5.35, CI 0.87 to 23.81). Intermittent urinary catheterization (OR 2.05, CI 1.00 to 4.22) and Foley placement (OR 3.69, CI 1.55 to 8.80) were associated with a higher risk of subsequent delirium. After adjusting for presence of dementia, only Foley placement in the ED remained significantly associated with development of in-hospital delirium (adjusted OR 3.16, CI 1.22 to 7.53). Conclusion: ED LOS and ED opioid use were not associated with higher risk of incident delirium in this cohort. Urinary catheterization in the ED was associated with an increased risk of subsequent delirium. These findings can be used to design ED-based initiatives and increase delirium prevention efforts.
MeSH term(s)	Aged ; Aged, 80 and over ; Analgesics, Opioid/adverse effects ; Benzodiazepines/therapeutic use ; Delirium/chemically induced ; Delirium/etiology ; Emergency Service, Hospital ; Female ; Geriatric Assessment ; Hospitalization ; Humans ; Male ; Prospective Studies ; Risk Factors
Chemical Substances	Analgesics, Opioid ; Benzodiazepines (12794-10-4)
Language	English
Publishing date	2021-12-17
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2021.12.032
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Article ; Online: Advancing specificity in delirium: The delirium subtyping initiative.

Bowman, Emily M L / Brummel, Nathan E / Caplan, Gideon A / Cunningham, Colm / Evered, Lis A / Fiest, Kirsten M / Girard, Timothy D / Jackson, Thomas A / LaHue, Sara C / Lindroth, Heidi L / Maclullich, Alasdair M J / McAuley, Daniel F / Oh, Esther S / Oldham, Mark A / Page, Valerie J / Pandharipande, Pratik P / Potter, Kelly M / Sinha, Pratik / Slooter, Arjen J C /

Sweeney, Aoife M / Tieges, Zoë / Van Dellen, Edwin / Wilcox, Mary Elizabeth / Zetterberg, Henrik / Cunningham, Emma L

Alzheimer's & dementia : the journal of the Alzheimer's Association

2023 Volume 20, Issue 1, Page(s) 183–194

Abstract: Background: Delirium, a common syndrome with heterogeneous etiologies and clinical presentations, is associated with poor long-term outcomes. Recording and analyzing all delirium equally could be hindering the field's understanding of pathophysiology ... ...

Abstract	Background: Delirium, a common syndrome with heterogeneous etiologies and clinical presentations, is associated with poor long-term outcomes. Recording and analyzing all delirium equally could be hindering the field's understanding of pathophysiology and identification of targeted treatments. Current delirium subtyping methods reflect clinically evident features but likely do not account for underlying biology. Methods: The Delirium Subtyping Initiative (DSI) held three sessions with an international panel of 25 experts. Results: Meeting participants suggest further characterization of delirium features to complement the existing Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision diagnostic criteria. These should span the range of delirium-spectrum syndromes and be measured consistently across studies. Clinical features should be recorded in conjunction with biospecimen collection, where feasible, in a standardized way, to determine temporal associations of biology coincident with clinical fluctuations. Discussion: The DSI made recommendations spanning the breadth of delirium research including clinical features, study planning, data collection, and data analysis for characterization of candidate delirium subtypes. Highlights: Delirium features must be clearly defined, standardized, and operationalized. Large datasets incorporating both clinical and biomarker variables should be analyzed together. Delirium screening should incorporate communication and reasoning.
MeSH term(s)	Humans ; Delirium/diagnosis ; Delirium/etiology ; Research Design ; Data Collection ; Diagnostic and Statistical Manual of Mental Disorders
Language	English
Publishing date	2023-07-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	2211627-8
ISSN	1552-5279 ; 1552-5260
ISSN (online)	1552-5279
ISSN	1552-5260
DOI	10.1002/alz.13419
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