In-hospital cardiac arrests (IHCA) are a significant healthcare issue. A way to improve outcomes is through quality improvement (QI) efforts. This requires the collection and analysis of core metrics. Many hospitals in the United States lack robust data and/or data systems to support QI initiatives.
Purpose: This EBP project entailed development of an in-hospital, small-scaled registry. It is designed for hospitals unable to participate in a national registry due to cost or lack of adequate resources.
Project description: The developer utilized research to identify key metrics essential to improved cardiac arrest care. These key metrics were used as core data elements in the registry. Utilizing best practices in software development, the author developed a "simple-to-use" registry. Healthcare professionals who were not formal abstractors performed functional and usability testing on the registry. The user experience questionnaire (UEQ) was utilized to provide an evaluation of the system. Improvements were made based upon feedback, and the system was moved from development to implementation into a 68-bed short-term acute care suburban community hospital.
System description: The system was built with available technologies to the organization, thus not incurring any additional cost for new software or technology. The system utilized Microsoft 365 as the framework building on existing organizational access permissions. Data were stored using Microsoft Lists on a SharePoint team site. Microsoft Lists offered many features that a traditional spreadsheet offers with some added benefits and without the overhead or complexity of a database system. With Microsoft Lists, permissions were maintained on the data independent of the application providing an additional level of security. The registry data entry system was developed as a canvas application on the Microsoft Power Apps platform. A multipage data entry system was a key part of the design to keep the interface simple and organize data components. Data validation was built into the app with many of the data fields utilizing a selection dropdown boxes rather than free text entry to ensure data consistency. The Power Apps design supported data entry via desktop, tablet, or mobile device. After initial testing, the author added a reporting tool utilizing Microsoft Power BI. Data feeds were automated to a Power BI dataset updating two times per day. Sample data report with four demographic and incident metrics were configured. The data reports were additionally expanded into an interactive dashboard, fully customizable by the hospital.
Outcome: A small group of users evaluated the registry for usability. Scores for attractiveness, perspicuity, efficiency, dependability, stimulation, and novelty were obtained via UEQ instrument. When benchmark analysis was performed the registry scored in the top 10% of 4 of the 6 subscales, and top 25% on the other scales.
Conclusion: A "home-grown" registry is a viable alternative to a national registry when financial and human resources are limited. This registry is easily ported from platforms and is an extensible, scalable solution. It is a resource for other hospitals and a model of how to moving to data-driven quality improvement.
After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.