title: Process improvement methods increase the efficiency, accuracy, and utility of a neurocritical care research repository.
abstract: BACKGROUND
  Reliable and efficient data repositories are essential for the advancement of research in Neurocritical care. Various factors, such as the large volume of patients treated within the neuro ICU, their differing length and complexity of hospital stay, and the substantial amount of desired information can complicate the process of data collection.
  
  
  METHODS
  We adapted the tools of process improvement to the data collection and database design of a research repository for a Neuroscience intensive care unit. By the Shewhart-Deming method, we implemented an iterative approach to improve the process of data collection for each element. After an initial design phase, we re-evaluated all data fields that were challenging or time-consuming to collect. We then applied root-cause analysis to optimize the accuracy and ease of collection, and to determine the most efficient manner of collecting the maximal amount of data.
  
  
  RESULTS
  During a 6-month period, we iteratively analyzed the process of data collection for various data elements. For example, the pre-admission medications were found to contain numerous inaccuracies after comparison with a gold standard (sensitivity 71% and specificity 94%). Also, our first method of tracking patient admissions and discharges contained higher than expected errors (sensitivity 94% and specificity 93%). In addition to increasing accuracy, we focused on improving efficiency. Through repeated incremental improvements, we reduced the number of subject records that required daily monitoring from 40 to 6 per day, and decreased daily effort from 4.5 to 1.5 h/day.
  
  
  CONCLUSIONS
  By applying process improvement methods to the design of a Neuroscience ICU data repository, we achieved a threefold improvement in efficiency and increased accuracy. Although individual barriers to data collection will vary from institution to institution, a focus on process improvement is critical to overcoming these barriers.
authors.affiliation: Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Lunder 644, 45 Fruit Street, Boston, MA, USA.
authors.forename: Sydney
authors.initials: S
authors.lastname: O'Connor
authors.forename: Alison
authors.initials: A
authors.lastname: Ayres
authors.forename: Lynelle
authors.initials: L
authors.lastname: Cortellini
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.forename: Eric
authors.initials: E
authors.lastname: Rosenthal
authors.forename: W Taylor
authors.initials: WT
authors.lastname: Kimberly
mesh_terms: D000328:Adult; D000368:Aged; D035843:Biomedical Research / Q000379:methods / Q000592:standards; D003422:Critical Care / Q000379:methods* / Q000458:organization & administration / Q000592:standards*; D016638:Critical Illness / Q000628:therapy*; D003625:Data Collection / Q000379:methods* / Q000592:standards*; D016208:Databases, Factual / Q000592:standards*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D010343:Patient Admission / Q000592:standards; D010351:Patient Discharge / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods / Q000458:organization & administration; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity