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CC BY-NC-ND 4.0 · Appl Clin Inform 2023; 14(05): 892-902
DOI: 10.1055/a-2165-5861
Research Article

The Intensive Care Unit Bundle Board: A Novel Real-Time Data Visualization Tool to Improve Maintenance Care for Invasive Catheters

Claire Leilani Davis
1   Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, United States
,
Margot Bjoring
2   Department of Quality and Performance Improvement, University of Virginia Health System, Charlottesville, Virginia, United States
,
Jordyn Hursh
3   Department of Nursing, University of Virginia Health System, Charlottesville, Virginia, United States
,
Samuel Smith
3   Department of Nursing, University of Virginia Health System, Charlottesville, Virginia, United States
,
Cheri Blevins
3   Department of Nursing, University of Virginia Health System, Charlottesville, Virginia, United States
,
Kris Blackstone
3   Department of Nursing, University of Virginia Health System, Charlottesville, Virginia, United States
,
Evie Nicholson
2   Department of Quality and Performance Improvement, University of Virginia Health System, Charlottesville, Virginia, United States
,
Tracey Hoke
2   Department of Quality and Performance Improvement, University of Virginia Health System, Charlottesville, Virginia, United States
,
Jonathan Michel
2   Department of Quality and Performance Improvement, University of Virginia Health System, Charlottesville, Virginia, United States
,
Imre Noth
1   Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, United States
,
Andrew Barros
1   Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, United States
,
Kyle Enfield
1   Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, United States
› Author Affiliations Funding The study was funded by National Center for Advancing Translational Sciences of the National Institutes of Health awards (award nos.: KL2TR003016 and UL1TR003015).
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Abstract

Background Critically ill patients are at greater risk of healthcare-associated infections (HAIs). The use of maintenance bundles helps to reduce this risk but also generates a rapid accumulation of complex data that is difficult to aggregate and subsequently act upon.

Objectives We hypothesized that a digital display summarizing nursing documentation of invasive catheters (including central venous access devices, arterial catheters, and urinary catheters) would improve invasive device maintenance care and documentation. Our secondary objectives were to see if this summary would reduce the duration of problematic conditions, that is, characteristics associated with increased risk of infection.

Methods We developed and implemented a data visualization tool called the “Bundle Board” to display nursing observations on invasive devices. The intervention was studied in a 28-bed medical intensive care unit (MICU). The Bundle Board was piloted for 6 weeks in June 2022 and followed by a comparison phase, where one MICU had Bundle Board access and another MICU at the same center did not. We retrospectively applied tile color coding logic to prior nursing documentation from 2021 until the pilot phase to facilitate comparison pre- and post-Bundle Board release.

Results After adjusting for time, other quality improvement efforts, and nursing shift, multiple linear regression demonstrated a statistically significant improvement in the completion of catheter care and documentation during the pilot phase (p < 0.0001) and comparison phase (p = 0.002). The median duration of documented problematic conditions was significantly reduced during the pilot phase (p < 0.0001) and in the MICU with the Bundle Board (comparison phase, p = 0.027).

Conclusion We successfully developed a data visualization tool that changed ICU provider behavior, resulting in increased completion and documentation of maintenance care and reduced duration of problematic conditions for invasive catheters in MICU patients.

Keywords

data visualization tool - critical care medicine - nursing documentation - cognitive load - dashboard - quality improvement - Bundle Board

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was approved by the Institutional Review Board for Health Sciences Research (HSR #18887).


Supplementary Material



Publication History

Received: 26 May 2023

Accepted: 14 August 2023

Accepted Manuscript online:
04 September 2023

Article published online:
15 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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