Creating Surveillance Data Infrastructure Using Laboratory Analytics: Leveraging Visiun and Epic Systems to Support COVID-19 Pandemic Response.

BACKGROUND: Pandemics are unpredictable and can rapidly spread. Proper planning and preparation for managing the impact of outbreaks is only achievable through continuous and systematic collection and analysis of health-related data. We describe our experience on how to comply with required reporting and develop a robust platform for surveillance data during an outbreak. MATERIALS AND METHODS: At Mount Sinai Health System, New York City, we applied Visiun, a laboratory analytics dashboard, to support main response activities. Epic System Inc.'s SlicerDicer application was used to develop clinical and research reports. We followed World Health Organization (WHO); federal and state guidelines; departmental policies; and expert consultation to create the framework. RESULTS: The developed dashboard integrated data from scattered sources are used to seamlessly distribute reports to key stakeholders. The main report categories included federal, state, laboratory, clinical, and research. The first two groups were created to meet government and state reporting requirements. The laboratory group was the most comprehensive category and included operational reports such as performance metrics, technician performance assessment, and analyzer metrics. The close monitoring of testing volumes and lab operational efficiency was essential to manage increasing demands and provide timely and accurate results. The clinical data reports were valuable for proper managing of medical surge requirements, such as healthcare workforce and medical supplies. The reports included in the research category were highly variable and depended on healthcare setting, research priorities, and available funding. We share a few examples of queries that were included in the designed framework for research projects. CONCLUSION: We reviewed here the key components of a conceptual surveillance framework required for a robust response to COVID-19 pandemics. We demonstrated leveraging a lab analytics dashboard, Visiun, combined with Epic reporting tools to function as a surveillance system. The framework could be used as a generic template for possible future outbreak events.

Consensus-validation study identifies relevant nursing diagnoses, nursing interventions, and health outcomes for people with traumatic brain injuries.

A consensus-validation study used action research methods to identify relevant nursing diagnoses, nursing interventions, and patient outcomes for a population of adults with traumatic brain injury (TBI) in long-term care. In meetings totaling 159 hours to reach 100% consensus through group discussions, the three classifications of NANDA International's (NANDA-I's) approved nursing diagnoses, the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC) were used as the basis for three nurses experienced in working with adults with TBI to select the elements of nursing care. Among almost 200 NANDA-I nursing diagnoses, 29 were identified as relevant for comprehensive nursing care of this population. Each nursing diagnosis was associated with 3-11 of the more than 500 NIC interventions and 1-13 of more than 300 NOC outcomes. The nurses became aware of the complexity and the need for critical thinking. The findings were used to refine the facility's nursing standards of care, which were to be combined with the interdisciplinary plan of care and included in future electronic health records.

Enhanced toileting program decreases incontinence in long term care.

BACKGROUND: Incontinence is a common problem in long term care. In March 2003, in reviewing its performance on the Minimum Data Set (MDS 3.0) quality indicators, Sea View Hospital Rehabilitation Center and Home, a 304-bed long term care facility in Staten Island, New York, discovered it was 39% above the average of the state and national means for the incontinence indicators. In response, it initiated a facilitywide performance improvement project. METHODS: Processes identified in the action plan for the project, "Residents who trigger for occasional or frequent bowel and bladder incontinence on MDS will be assessed for an individualized toileting schedule," included (1) revision of assessment documentation, which improved the initial assessment of continence, with an added reassessment process; (2) documentation of the toileting plan on the Patient Care Technician Assignment Card and the Activity of Daily Living Accountability Sheet; (3) adoption of toilet-assist devices; (4) hospitalwide in-service on incontinence and toileting; and (5) revision of the bowel and bladder incontinence policy. RESULTS: After implementation of the revised bowel and bladder incontinence assessment tool, the rate of incontinence without a toileting plan decreased--from 79% to 38%--and remained below the yearly mean. DISCUSSION: The new assessment processes made individualized planning possible and accurate. This initiative could be easily replicated because it requires resources that are basic to most long term care facilities.