Improving Identification And Coordination Of Mobility Interventions In The ICU Using Clinical Decision Support
The ASSIST-ICU clinical decision support system (CDSS) holds promise for assisting intensive care unit (ICU) nurses and physical therapists to make more efficient and informed decisions about delivery of evidence-based physical activity interventions at the point of care.
Project Details -
Ongoing
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Grant NumberR21 HS029959
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AHRQ Funded Amount$971,260
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Principal Investigator(s)
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Organization
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LocationIowa CityIowa
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Project Dates04/01/2024 - 03/31/2029
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Technology
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Care Setting
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Type of Care
Each year, more than 5 million adults are admitted to ICUs in the United States, and an alarming 50 percent will develop hospital-acquired functional decline, impairing their ability to perform self-care activities due in part to prolonged immobility. This condition is associated with additional negative outcomes, including readmission, extended hospitalization, nursing home admission, inability to return to work, and premature death, highlighting the urgent need to improve physical activity in ICUs. Guidelines for ICU patients’ physical activity exist, and evidence shows that interventions can prevent hospital-acquired functional decline. However, physical activity decisions are complex, and implementing interventions is challenging. To synthesize patient data, ICU staff (registered nurses and physical therapists) must navigate numerous locations in the electronic health record (EHR), which, when combined with the dynamic nature of critical illness, creates significant cognitive demands for staff and makes the timely identification of suitable patients for this intervention difficult. Consequently, evidence-based physical activity interventions are often underused, consistent with the reported data that fewer than half of ICUs in the United States report having physical activity programs.
To address these challenges, this study will develop and evaluate ASSIST-ICU, a digital CDSS for consistent, evidence-based, patient-specific physical activity interventions in ICU settings.
The specific aims of the research are as follows:
- Develop a useable, useful, and acceptable ASSIST-ICU prototype.
- Integrate the EHR CDSS interface and finalize the implementation plan for evaluating the effectiveness of the ASSIST-ICU CDSS.
- Determine the usability, cognitive workload, acceptability, and effectiveness of ASSIST-ICU for activity guideline adoption in a simulated EHR environment.
- Determine the effectiveness, usability, cognitive workload, acceptability, and post-implementation feasibility of ASSIST-ICU in a real-world pragmatic trial.
Building on prior work that developed and validated an algorithm to integrate EHR data with physical activity guidelines, researchers will use mixed methods in two phases. In Phase 1, researchers will develop a CDSS prototype using a user-centered design approach with ICU staff. Researchers will also identify clinical workflow considerations, potential barriers, and implementation strategies in preparation for evaluating the CDSS. In Phase 2, researchers will evaluate the CDSS's effectiveness, usability, acceptability, and feasibility in a simulated EHR environment and in a pragmatic trial with two ICU units in a tertiary care hospital, integrating within an Epic EHR system.
This study holds promise for assisting ICU staff in efficiently delivering personalized, evidence-based, physical activity plans through the use of a point of care CDSS. By automating the integration of patient data with guideline recommendations, the need for manual processing is eliminated, thus streamlining the identification of suitable patients and reducing the cognitive burdens placed on staff. The anticipated results are expected to strongly support a subsequent multi-site clinical trial aimed at reducing bedrest duration and minimizing hospital-acquired functional decline and associated costs.