Secondary use of data extracted from a clinical information system to assess the adherence of tidal volume and its impact on outcomes

Abstract

Objectives: To extract data from clinical information systems to automatically calculate high-resolution quality indicators to assess adherence to recommendations for low tidal volume.

Design: We devised two indicators: the percentage of time under mechanical ventilation with excessive tidal volume (>8mL/kg predicted body weight) and the percentage of patients who received appropriate tidal volume (≤8mL/kg PBW) at least 80% of the time under mechanical ventilation. We developed an algorithm to automatically calculate these indicators from clinical information system data and analyzed associations between them and patients' characteristics and outcomes.

Settings: This study has been carried out in our 30-bed polyvalent intensive care unit between January 1, 2014 and November 30, 2019.

Patients: All patients admitted to intensive care unit ventilated >72h were included.

Intervention: Use data collected automatically from the clinical information systems to assess adherence to tidal volume recommendations and its outcomes.

Main variables of interest: Mechanical ventilation days, ICU length of stay and mortality.

Results: Of all admitted patients, 340 met the inclusion criteria. Median percentage of time under mechanical ventilation with excessive tidal volume was 70% (23%-93%); only 22.3% of patients received appropriate tidal volume at least 80% of the time. Receiving appropriate tidal volume was associated with shorter duration of mechanical ventilation and intensive care unit stay. Patients receiving appropriate tidal volume were mostly male, younger, taller, and less severely ill. Adjusted intensive care unit mortality did not differ according to percentage of time with excessive tidal volume or to receiving appropriate tidal volume at least 80% of the time.

Conclusions: Automatic calculation of process-of-care indicators from clinical information systems high-resolution data can provide an accurate and continuous measure of adherence to recommendations. Adherence to tidal volume recommendations was associated with shorter duration of mechanical ventilation and intensive care unit stay.

Keywords: Clinical information system; Indicadores de calidad; Mechanical ventilation; Quality indicators; Sistemas de Información Clínica; Tidal volume; Ventilación mecánica; Volumen tidal.