Cognitive support for a better handoff: does it improve the quality of medical communication at shift change in an emergency department?

in European Journal of Emergency Medicine (in press)

In order to improve the communication during shift handover in an emergency department, we observed the handover process and analysed the discourse between physicians at shift change first, then we ... [more ▼]

In order to improve the communication during shift handover in an emergency department, we observed the handover process and analysed the discourse between physicians at shift change first, then we created two cognitive tools and tested their clinical impact on the field. We used different measures to evaluate this impact on the health care process including frequency and type of information content communicated between physicians, duration of the handoff, physician self-evaluation of the quality of the handoff and a post-handover study of patient handling. Our results showed that the patient's medical history, significant tests results, recommendations (treatment plan) and patient follow-up were communicated to a greater extent when the tools are used. We also demonstrated that physicians spent more time at the bedside and less time consulting medical records using these tools. [less ▲]

ELISA : ECHELLE LIÉGEOISE DE L’INDICE DE SÉVÉRITÉ À L’ADMISSION

in Revue Médicale de Liège (2012), 67(12), 632-637

Les services d’urgence sont régulièrement confrontés au problème d’encombrement à l’admission par une demande qui dépasse l’offre de soins. Il est essentiel de réguler le flux d’entrée par la mise en ... [more ▼]

Les services d’urgence sont régulièrement confrontés au problème d’encombrement à l’admission par une demande qui dépasse l’offre de soins. Il est essentiel de réguler le flux d’entrée par la mise en place d’un dispositif de tri. Ce mécanisme s’affine depuis une quinzaine d’années. Nous proposons un algorithme de tri (ELISA ou Echelle Liégeoise de l’Indice de Sévérité à l’Admission) qui vise à définir l’état d’urgence selon 5 niveaux depuis la catégorie U1 (urgence absolue) à U5 (urgence relative). Ces niveaux sont associés à un délai de contact médical (immédiat à 120 minutes) et à un trajet de soin correspondant (salle de déchoquage, secteur B ou brancard, secteur A ou ambulatoire, salle d’attente) réunissant ainsi des impératifs de temps et de lieu de prise en charge optimaux. Notre algorithme de tri montre une excellente fiabilité par la comparaison du niveau initial de la catégorisation au devenir du patient (soins intensifs, hospitalisation, et sortie du service). [less ▲]

Cognitive support for a better handoff: does it improve the quality of medical communication at shift change in an emergency department?

in European journal of emergency medicine : official journal of the European Society for Emergency Medicine (2012)

AIM: To improve the communication during shift handover in an emergency department. METHODS: We observed the handover process and analysed the discourse between physicians at shift change first, and then ... [more ▼]

AIM: To improve the communication during shift handover in an emergency department. METHODS: We observed the handover process and analysed the discourse between physicians at shift change first, and then we created two cognitive tools and tested their clinical impact on the field. We used different measures to evaluate this impact on the health care process including the frequency and type of information content communicated between physicians, duration of the handoff, physician self-evaluation of the quality of the handoff and a posthandover study of patient handling. RESULTS: Our results showed that the patient's medical history, significant test results, recommendations (treatment plan) and patient follow-up were communicated to a greater extent when the tools are used. We also found that physicians spent more time at the bedside and less time consulting medical records using these tools. CONCLUSION: The present study showed how in-depth observations and analyses of real work processes can be used to better support the quality of patient care. [less ▲]

Assessment of ventricular contractility and ventricular-arterial coupling with a model-based sensor.

in Computer Methods & Programs in Biomedicine (2012)

Estimation of ventricular contractility and ventricular arterial coupling is clinically important in diagnosing and treating cardiac dysfunction in the critically ill. However, experimental assessment of ... [more ▼]

Estimation of ventricular contractility and ventricular arterial coupling is clinically important in diagnosing and treating cardiac dysfunction in the critically ill. However, experimental assessment of indexes of ventricular contractility, such as the end-systolic pressure-volume relationship, requires a highly invasive maneuver and measurements that are not typical in an intensive care unit (ICU). This research describes the use of a previously validated cardiovascular system model and parameter identification process to evaluate the right ventricular arterial coupling in septic shock. Model-based ventricular arterial coupling is defined by the ratio of the end systolic right ventricular elastance (E(esrvf)) over the pulmonary artery elastance (E(pa)) or the mean pulmonary inflow resistance (R(pulin)). Results are compared to the clinical gold-standard assessment (conductance catheter method). Six anesthetized healthy pigs weighing 20-30kg received a 0.5mgkg(-1) endotoxin infusion over a period of 30min from T0 to T30, to induce septic shock and veno-venous hemofiltration was used from T60 onward. The results show good agreement with the gold-standard experimental assessment. In particular, the model-based right ventricular elastance (E(esrvf)) correlates well with the clinical gold standard (R(2)=0.69) and the model-based non-invasive coupling (E(esrvf)/R(pulin)) follow the same trends and dynamics (R(2)=0.37). The overall results show the potential to develop a model-based sensor to monitor ventricular-arterial coupling in clinical real-time. [less ▲]

Model-based Monitoring of Septic Shock Treated with Large-Pore Hemofiltration Therapy

in Proceedings of BMS 2012 (2012)

Algorithmic Processing of Pressure Waveforms to FacilitateEstimation of Cardiac Elastance

in BioMedical Engineering OnLine (2012), 11

Introduction: Cardiac elastances are highly invasive to measure directly, but are clinically useful due tothe amount of information embedded in them. Information about the cardiac elastance, which can be ... [more ▼]

Introduction: Cardiac elastances are highly invasive to measure directly, but are clinically useful due tothe amount of information embedded in them. Information about the cardiac elastance, which can be used toestimate it, can be found in the downstream pressure waveforms of aortic pressure (Pao) and the pulmonaryartery (Ppa). However these pressure waveforms are typically noisy and biased, and require processing in orderto locate the specific information required for the cardiac elastance estimation. This paper presents the methodto algorithmically process the pressure waveforms. Methods: A shear transform is developed in order to helplocate information in the pressure waveforms. This transform turns difficult to locate corners into easy to locatemaximum or minimum points as well as providing error correction. Results: The method located all points 87out of 88 waveforms for Ppa to within the sampling frequency. For Pao, out of 616 total points, 605 were foundwithin 1%, 5 within 5%, 4 within 10% and 2 within 20%. Conclusions: The presented method provides arobust, accurate and dysfunction independent way to locate points on the aortic and pulmonary artery pressurewaveforms, allowing the non-invasive estimation of the left and right cardiac elastance. [less ▲]

A medieval shot

Poster (2012)

Blue... is a bad sign

Poster (2012)

Patient specific identification of the cardiac driver function in a cardiovascular system model.

in Computer Methods & Programs in Biomedicine (2011)

The cardiac muscle activation or driver function, is a major determinant of cardiovascular dynamics, and is often approximated by the ratio of the left ventricle pressure to the left ventricle volume. In ... [more ▼]

The cardiac muscle activation or driver function, is a major determinant of cardiovascular dynamics, and is often approximated by the ratio of the left ventricle pressure to the left ventricle volume. In an intensive care unit, the left ventricle pressure is usually never measured, and the left ventricle volume is only measured occasionally by echocardiography, so is not available real-time. This paper develops a method for identifying the driver function based on correlates with geometrical features in the aortic pressure waveform. The method is included in an overall cardiovascular modelling approach, and is clinically validated on a porcine model of pulmonary embolism. For validation a comparison is done between the optimized parameters for a baseline model, which uses the direct measurements of the left ventricle pressure and volume, and the optimized parameters from the approximated driver function. The parameters do not significantly change between the two approaches thus showing that the patient specific approach to identifying the driver function is valid, and has potential clinically. [less ▲]

Model-based cardiovascular monitoring of large pore hemofiltration during endotoxic shock in pigs

in Critical Care: the Official Journal of the Critical Care Forum (2011), 15 (Suppl 1)