Use of a Portable Electronic Interface Improves Clinical Handoffs and Adherence to Lung Protective Ventilation

Neil R Euliano; Paul Stephan; Konstantinos Michalopoulos; Michael A Gentile; A Joseph Layon; Andrea Gabrielli

doi:10.2147/MDER.S372333

Use of a Portable Electronic Interface Improves Clinical Handoffs and Adherence to Lung Protective Ventilation

Med Devices (Auckl). 2022 Aug 5:15:263-275. doi: 10.2147/MDER.S372333. eCollection 2022.

Authors

Neil R Euliano¹, Paul Stephan¹, Konstantinos Michalopoulos¹, Michael A Gentile², A Joseph Layon³, Andrea Gabrielli⁴

Affiliations

¹ Convergent Engineering, Inc, Gainesville, FL, USA.
² Department of Anesthesiology, Duke University, Durham, NC, USA.
³ Department of Anesthesiology, College of Medicine, University of Central Florida, Orlando, FL, USA.
⁴ Miller School of Medicine, University of Miami, Miami, FL, USA.

Abstract

Background: Mechanical ventilation (MV) is used to support patients with respiratory impairment. Evidence supports the use of lung-protective ventilation (LPV) during MV to improve outcomes. However, studies have demonstrated poor adherence to LPV guidelines. We hypothesized that an electronic platform adapted to a hand-held tablet receiving real-time ventilatory parameters could increase clinician awareness of key LPV parameters. Furthermore, we speculated that an electronic shift-change tool could improve the quality of clinician handoffs.

Methods: Using a specially designed Wi-Fi dongle to transmit data from three ventilators and a respiratory monitor, we implemented a system that displays data from all ventilators under the care of a Respiratory Care Practitioner (RCP) on an electronic tablet. In addition, the tablet created a handoff checklist to improve shift-change communication. In a simulated ICU environment, we monitored the performance of eight RCPs at baseline and while using the system.

Results: Using the system, the time above guideline Pplat decreased by 74% from control, and the time outside the VT range decreased by 60% from control, p = 0.007 and 0.015, respectively. The handoff scores improved quality significantly from 2.8 to 1.6 on a scale of 1 to 5 (1 being best), p = 0.03.

Conclusion: In a simulated environment, an electronic RT tool can significantly improve shift-change communication and increase the RCP's level of LPV adherence.

Keywords: clinical decision support software; handoff; health information technology; lung protective ventilation; respiration; respiratory therapy.

Grants and funding

This work was supported by the National Institute of Health – National Heart, Lung, and Blood research grant # 1R43HL146012-01A1 “RT Assistant – handheld patient safety tool for mechanical ventilation”.