Generating insights in uncharted territories: real-time learning from data in critically ill patients-an implementer report.

Introduction In the current situation, clinical patient data are often siloed in multiple hospital information systems. Especially in the intensive care unit (ICU), large volumes of clinical data are routinely collected through continuous patient monitoring. Although these data often contain useful information for clinical decision making, they are not frequently used to improve quality of care. During, but also after, pressing times, data-driven methods can be used to mine treatment patterns from clinical data to determine the best treatment options from a hospitals own clinical data.Methods In this implementer report, we describe how we implemented a data infrastructure that enabled us to learn in real time from consecutive COVID-19 ICU admissions. In addition, we explain our step-by-step multidisciplinary approach to establish such a data infrastructure.Conclusion By sharing our steps and approach, we aim to inspire others, in and outside ICU walls, to make more efficient use of data at hand, now and in the future.

Feasibility first: developing public performance indicators on patient safety and clinical effectiveness for Dutch hospitals.

This paper describes the development and implementation of the first national, public and obligatory set of hospital performance indicators in the Netherlands. Focusing on effectiveness and safety, the set was developed by the Dutch Health Care Inspectorate to improve the effectiveness and efficiency of their task: monitoring the quality of the care delivered by providers. In addition, the set would enhance the transparency of the hospital sector, and stimulate individual hospitals to improve their scores. Bridging some of the classic distinctions between 'internal' and 'external' indicators, the Inspectorate's vision was to rapidly produce a feasible set of indicators that would fulfill these aims, while maximally preventing 'side effects' such as misinterpretations, defensive or perverse reactions. Explicitly avoiding the trap of searching for exhaustive validity of the indicators, the inspectorate's motto was 'feasability first'. This paper describes how this simultaneously philosophical, political and pragmatic strategy played out successfully, and how the indicator set was ultimately embraced by all parties involved.