Timely Data for Targeted Quality Improvement Interventions: Use of a Visual Analytics Dashboard for BronchiolitisFunding None.
19 September 2018
10 January 2019
06 March 2019 (online)
Background Standard methods for obtaining data may delay quality improvement (QI) interventions including for bronchiolitis, a common cause of childhood hospitalization.
Objective To describe the use of a dashboard in the context of a multifaceted QI intervention aimed at reducing the use of chest radiographs, bronchodilators, antibiotics, steroids, and viral testing in patients with bronchiolitis.
Methods This QI initiative took place at Children's Minnesota, a large, not-for-profit children's health care organization. A multidisciplinary bronchiolitis workgroup developed a local clinical guideline and order-set. Delays in obtaining baseline data prompted a pediatric hospitalist and information technology specialist to modify a vendor's dashboard to display data related to bronchiolitis guideline metrics. Patients 2 months to 2 years old with a bronchiolitis emergency department (ED)/inpatient encounter in the period October 1, 2014 to April 30, 2018 were included. The primary outcome was a functioning dashboard; a process measure was the percentage of ED clinician logins. Outcome measures included the percent use of guideline metrics (e.g., bronchodilators) displayed on statistical process control charts (ED vs. inpatient). Balancing measures included length of stay, charge ratios, and hospital revisits.
Results A workgroup (formed October 2015) implemented a bronchiolitis order-set and guideline (February 2016) followed by a bronchiolitis dashboard (August 2016) consolidating disparate data sources loaded within 2 to 4 days of discharge. In total, 35% of ED clinicians logged in. Leaders used the dashboard to target and track interventions such as a bronchodilator order alert. There were improvements in most outcome metrics; however, timing did not suggest direct dashboard impact. ED balancing measures were lower after implementation.
Conclusion We described use of a dashboard to support a multifaceted QI initiative for bronchiolitis. Leaders used the dashboard for targeted interventions but the dashboard did not directly impact the observed improvements. Future studies should assess reasons for low individual dashboard use.
Dr. Hester conceptualized and designed the study, led the implementation of the guideline, assisted in dashboard development, drafted the initial manuscript, performed statistical analyses, prepared several figures, and approved the final manuscript as submitted. Mr. Lang was the IT dashboard developer and led dashboard development, performed analyses, prepared several figures, critically reviewed the manuscript, and approved the final manuscript as submitted. Ms. Madsen and Dr. Tambyraja were IT leaders who assisted with organizational dashboard implementation, assisted in bronchiolitis dashboard development, participated in the guideline review, critically reviewed the manuscript, and approved the final manuscript as submitted. Dr. Zenker was an emergency department lead for the guideline implementation, assisted in dashboard development, critically reviewed the manuscript, and approved the final manuscript as submitted.
Protection of Human and Animal Subjects
There were no implications (e.g., financial) to clinicians as a result of this initiative. This study was deemed QI and exempt from further review by the organization's Institutional Review Board.
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