title: Automating Quality Metrics in the Era of Electronic Medical Records: Digital Signatures for Ventilator Bundle Compliance.
abstract: Ventilator-associated events (VAEs) are associated with increased risk of poor outcomes, including death. Bundle practices including thromboembolism prophylaxis, stress ulcer prophylaxis, oral care, and daily sedation breaks and spontaneous breathing trials aim to reduce rates of VAEs and are endorsed as quality metrics in the intensive care units. We sought to create electronic search algorithms (digital signatures) to evaluate compliance with ventilator bundle components as the first step in a larger project evaluating the ventilator bundle effect on VAE. We developed digital signatures of bundle compliance using a retrospective cohort of 542 ICU patients from 2010 for derivation and validation and testing of signature accuracy from a cohort of random 100 patients from 2012. Accuracy was evaluated against manual chart review. Overall, digital signatures performed well, with median sensitivity of 100% (range, 94.4%-100%) and median specificity of 100% (range, 100%-99.8%). Automated ascertainment from electronic medical records accurately assesses ventilator bundle compliance and can be used for quality reporting and research in VAE.
authors.affiliation: Guang'anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing 100053, China ; Multidisciplinary Epidemiology and Translational Research in Critical Care, Perioperative and Emergency Medicine (METRIC-PM) Group, USA.
authors.forename: Haitao
authors.initials: H
authors.lastname: Lan
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Critical Care, Perioperative and Emergency Medicine (METRIC-PM) Group, USA ; Mayo Clinic, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Rochester, MN 55905, USA.
authors.forename: Charat
authors.initials: C
authors.lastname: Thongprayoon
authors.affiliation: North Central Texas Medical Foundation, Wichita Falls Family Practice Residency Program, Wichita Falls, TX 76301, USA.
authors.forename: Adil
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Critical Care, Perioperative and Emergency Medicine (METRIC-PM) Group, USA ; Mayo Clinic, Department of Anesthesiology, Division Critical Care Medicine, Rochester, MN 55905, USA.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Herasevich
authors.affiliation: Mayo Clinic, Department of Medicine, Division of Infectious Diseases, Rochester, MN 55905, USA.
authors.forename: Priya
authors.initials: P
authors.lastname: Sampathkumar
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Critical Care, Perioperative and Emergency Medicine (METRIC-PM) Group, USA ; Mayo Clinic, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Rochester, MN 55905, USA.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Critical Care, Perioperative and Emergency Medicine (METRIC-PM) Group, USA ; Mayo Clinic, Department of Medicine, Division of Infectious Diseases, Rochester, MN 55905, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: O'Horo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles / Q000379:methods* / Q000592:standards*; D010437:Peptic Ulcer / Q000517:prevention & control; D012121:Respiration, Artificial / Q000379:methods* / Q000592:standards*; D012189:Retrospective Studies; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000517:prevention & control