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  • Integration and medication in hospitals

    March 2017 | WorldCIST 2017

    This paper aimed to contribute to the development of a sociotechnical understanding and a robust implementation strategy of integration in health care by analysing how clinical practice and the history of existing systems play a crucial role in integration efforts. The authors use the implementation and integration of the large-scale Electronic Medication Management System (EMMS) MetaVision in the Health Authority Northern Norway, as an empirical example, with a focus on the integration challenges between the EMMS and the existing Electronic Patient Record (EPR) system. The MetaVision EMMS covers emergency units, intensive care and anaesthesia departments, operating rooms, outpatient clinics and clinical wards. The authors found that integration involves a lot of socio-technical and organisational issues that need to be addressed and highlight the importance of considering different stakeholders’ perspective as well as routine changes when large-scale integration projects are planned.

     

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  • How does a computerised nutritional protocol for mechanically ventilated critically ill patients effect energy and protein adequacy and outcome?

    February 2016 | Clinical Nutrition ESPEN

    A retrospective analysis of nutrition adequacy in adult mechanically ventilated critically ill patients before and after the implementation of an electronic nutritional protocol in MetaVision was performed at Gelderse Vallei Hospital in the Netherlands. The study was designed to address the effects of this protocol on energy and protein adequacy, electrolyte abnormalities, glucose regulation, workload and outcome. The computerized nutrition protocol provided automatic initiation suggestions and hourly feedback of energy and protein intake from feeding calories and non-nutritional calories such as glucose infusion, propofol and citrate renal replacement therapy (trisodium citrate). The authors found that the implementation of the electronic nutritional protocol reduced the rate of mechanically ventilated patients fed above target without reducing protein intake or increasing the rates of feeding below target, while reducing the incidence of electrolyte abnormalities. There were no statistical significant differences for other clinical outcomes. The protocol markedly reduced the time that dietitians spent on critically ill patients, as they no longer had to perform calculations to commence feeding.

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  • The first Dutch tele-ICU: Implementation and outcomes

    July 2015 | J Telemed Telecare

    An observational cohort study examined the implementation and outcomes, including patient and family satisfaction, of the first Dutch tele-ICU.  Since 6 December 2010, Onze Lieve Vrouwe Gasthuis (OLVG) intensivists provide remote care outside office hours for patients in MC Zuiderzee (MC-Z) Lelystad's ICU using MetaVision's remote ICU solution. The tele-intensivist has an audio–video connection to every bed, as well as a connection to a separate room in MC-Z for conversations with medical and nursing staff or with family. The tele-intensivist has access to all the medical information, decision support software and to the MetaVision PDMS, which is used at both hospitals but is not connected on a patient level. Local nurses, consultants and the tele-intensivist simultaneously use MetaVision. After collecting data for two years, the number of patients admitted for post-operative recovery reasons in the ICU was found to have decreased over time, explainable by a more stringent application of admission and discharge criteria by the tele-intensivist. The authors found this to be in accordance with the literature that shows a more efficient use of intensive care facilities in a 24/7 intensivist-led ICU compared to an ‘open format’. Due to a lack of data on severity of disease before implementation of the tele-intensive care, a standardized mortality ratio (SMR) from that period could not be calculated for comparison with the study period. However, the authors found that in comparison with other ICUs in the Netherlands, there was no signal of excess mortality based on the SMR calculated for the years 2012 and 2013 during the study period, within the given confidence intervals.  A survey of patient and family satisfaction, performed as part of the study, revealed that the tele-ICU solution was favourably received by patients and family members. The authors feel that the main strength of this descriptive study is that it is the first evaluation of a tele-ICU outside the USA.

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  • MetaVision facilitates anaesthesiology resident case logging at Hadassah – Hebrew University Medical Center

    January 2015 | International Journal of Medical Informatics

    Anaesthesiology residents are required to present a case log of all anaesthesias delivered and procedures performed in order to complete their training. In Israel, in contrast to the USA, UK and Canada, there is no central database for logging residents’ activities, and residents are expected to independently log the details of their cases and submit the log for board certification. Hadassah – Hebrew University Medical Center in Israel performed a study to evaluate the use and usability of a newly introduced system embedded in MetaVision that generates Quick Response (QR) codes for case logging. The QR code for each case contains all the relevant data for the syllabus based anaesthesia case log and could be scanned with a smartphone or tablet using a barcode scanner app. The data was then pasted into a spreadsheet file using a spreadsheet app, and the file could be saved locally and/or to the Cloud for backup. As part of the study, residents voluntarily answered anonymous questionnaires three times: before the QR code logging system was introduced, in order to assess their pre-existing case logging practices; three months post introduction, to assess QR code use and satisfaction; and again for usability and satisfaction after six months. The study found the system was being used by most of the residents three and six months after it was introduced. Usability was rated as very good or good, and high satisfaction was reported due to the system enabling residents to control their case logs and to do the logging immediately after finishing a case. The overall rate of case logging increased from 46.2% of residents before the introduction of the QR code system to 96% after six months. MetaVision enabled creation of the QR codes using VBScript coding.

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  • Electronic checklist in MetaVision improves transfer and retention of critical information at intraoperative handoffs

    January 2015 | Anesthesia & Analgesia

    Massachusetts General Hospital performed a prospective observational assessment to compare relay and retention of critical patient information between the outgoing and incoming anaesthesiologist before and after introduction of an electronic handoff checklist. The goal of the checklist, which was implemented via MetaVision, was to prompt discussion and improve communication at the transfer of care. The checklist contained the minimum amount of essential information required at handoff, and access to the checklist was designed to fit into the standard handoff process. The authors found that relay and retention of specific information improved with use of the checklist, with major improvements occurring in the areas of intraoperative medications and fluid balance, and communication. Use of the checklist, which was voluntary, was sustained at nearly 75%, and clinicians felt that quality of communication and identification of perioperative concerns at the end-of-shift handoff were significantly better after the introduction of the checklist. The study found that retention of information was also improved with use of the checklist. The study authors assess that "It is likely that some of the items on the checklist showed significant increase in transfer as a result of being brought forward from other parts of the anesthesia record, a unique benefit of an AIMS-based checklist…With use of the electronic checklist, information for patient weight, airway management, IV access, estimated blood loss, urine output, and antibiotic administration was displayed from previous entries in the record, and several of these items showed statistically significant improvements in information transfer with use of the checklist." Data on checklist usage were collected from MetaVision.

     

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  • Hôpital Pitié-Salpétrière uses MetaVision to highlight the benefits of electronic medical records

    December 2014 | Réanimation

    A study performed at Hôpital Pitié-Salpétrière in France examined the objectives, conception and expected benefits of electronic medical records (EMR) in the Intensive Care Unit. The study discusses how the right EMR can help address the complexity of managing ICU patients, and focuses on MetaVision as its primary example. Using two studies of patient outcomes based on paper records compared to the MetaVision EMR, the authors point out that while the impact of EMRs on mortality, ICU length of stay and duration of mechanical ventilation varies from study to study, the data suggest that the use of EMRs is advantageous. Due to the difficulty of designing multi-centre randomised controlled studies, the authors recommend retrospective case-control studies with a tight matching between patients as a next step.

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  • MetaVision alert for low potassium measurement can decrease the time to treatment of hypokalaemia

    March 2005 | Crit Care

    A study performed in the general ICU at the Sheba Medical Center in Israel found that implementing an alert for low potassium measurement using MetaVision's Event Manager resulted in a statistically significant reduction in the time to treatment of hypokalaemia. The study concludes that, "Computerized alerts regarding laboratory results may impact clinical care."

  • MV-ICU reduces documentation time

    January 2003 | Intensive Care Med

    This study shows that use of MetaVision in patients after cardiothoracic surgery alters nursing activity; it reduces the time for documentation and increases the time devoted to patient care.

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  • MV-ICU improves glucose regulation and guidelines adherence

    March 2005 | Journal of Medical Informatics Association

    Implementing a computerised version of a guideline significantly improved timeliness of measurements and glucose level regulation for critically ill patients compared with implementing a paper-based version of the guideline.

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  • MetaVision enhances accurate information on energy balance

    February 2006 | Clinical Nutrition

    Negative energy balance may be correlated with the occurrence of complications in the ICU. The bedside CIS provides accurate information on energy balance in critically ill patients and may allow for early detection and prevention of severe negative energy balance and complications.

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