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Clinical Evaluation of the "NICU Clinical Decision Support Dashboard" - CHMCO

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ClinicalTrials.gov Identifier: NCT03673566
Recruitment Status : Not yet recruiting
First Posted : September 17, 2018
Last Update Posted : October 3, 2018
Sponsor:
Collaborator:
Children's Hospital and Medical Center, Omaha, Nebraska
Information provided by (Responsible Party):
Philips Healthcare

Brief Summary:
This study evaluates the use of a NICU clinical integration system (Dashboard and accessories) in improving the quality of care delivered, patient health outcomes, and parent and clinician satisfaction. Clinicians will be asked to follow their current standard of care practices with the aid of this technology. About half of participants will receive care in NICU rooms with the Dashboard installed while the other half will receive standard care without the Dashboard.

Condition or disease Intervention/treatment Phase
Preterm Birth Low; Birthweight, Extremely (999 Grams or Less) Neonatal Infection Satisfaction Stress Chronic Lung Disease Growth Acceleration Adverse Event Device: NICU Dashboard Not Applicable

Detailed Description:

The current NICU environment can be stressful and overwhelming for parents of babies admitted and for clinicians caring for the babies. There is a wide range of monitors in a very clinical environment that does not take into account the comfort of neonates.

The Dashboard works in parallel with EHR and systems of record, and provides a cohesive view of the patient's status and planned clinical workflow in a single location for both parents and staff. Accessories such as environmental sensors and cameras are used to ensure that the environment is comfortable and promotes optimal development of the baby. Caregivers can educate and coach parents to facilitate integrating them into their infant's care. The NICU Dashboard also supports a family view to facilitate education and assist the family in tracking core measures and developmental milestones.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 581 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: The NICU is divided into two floors. One floor will have the Dashboard installed and serve as the intervention floor, while the other will not have the Dashboard and thus serves as the Control floor. As patients are admitted, they are randomly assigned to a room based on availability. Therefore, intervention and control arms will run in parallel in a quasi-randomized fashion.
Masking: None (Open Label)
Primary Purpose: Other
Official Title: Clinical Evaluation of the "NICU Clinical Decision Support Dashboard"
Estimated Study Start Date : March 2019
Estimated Primary Completion Date : July 2020
Estimated Study Completion Date : July 2020

Arm Intervention/treatment
Experimental: NICU Dashboard: Parent

The parental intervention group will have access to the parent application on the NICU Dashboard. Parents will be able to view basic information about their baby's condition, educational material, and track core measures and developmental milestones.

Parents of NICU babies will be asked to complete questionnaires at baseline and within 48 hours of NICU discharge.

Device: NICU Dashboard
The NICU Dashboard is displayed on a touch screen display mounted to the wall or on a rolling cart that will be placed near the bedside. The Dashboard will integrate information from various hospital/device sources in order to provide clinicians with one location to access and collectively interpret clinical findings and environmental factors. Parents will have their own view on the Dashboard that will allow them view their baby's progress, view educational materials, and have access to other resources at their fingertips.
Other Name: Lotus Dashboard

No Intervention: Standard Care: Parent
The Parental Control group will receive standard of care without any study devices.
Experimental: NICU Dashboard: Clinician

The Clinician group will have access to the NICU Dashboard, which presents information from the EHR, bedside monitoring, and other systems of record through a pre-released FDA Class 2 clinical decision support rule-based system, to assist the appropriate evidence-based guidelines be integrated with team workflows. Caregivers educate and coach parents to facilitate integrating them into their infant's care.

NICU clinicians will be asked to complete questionnaires 1) prior to clinical go-live of the intervention (baseline), 2) at the study mid-way point, and 3) upon completion of parent recruitment.

Device: NICU Dashboard
The NICU Dashboard is displayed on a touch screen display mounted to the wall or on a rolling cart that will be placed near the bedside. The Dashboard will integrate information from various hospital/device sources in order to provide clinicians with one location to access and collectively interpret clinical findings and environmental factors. Parents will have their own view on the Dashboard that will allow them view their baby's progress, view educational materials, and have access to other resources at their fingertips.
Other Name: Lotus Dashboard




Primary Outcome Measures :
  1. NICU Length of Stay [ Time Frame: From date of NICU admission until the date of NICU discharge, assessed up to 365 days ]
    Days spent in the NICU from admission to discharge


Secondary Outcome Measures :
  1. Incidence rate of Chronic Lung Disease [ Time Frame: Through study completion, an average of 1 year ]
    Diagnosis

  2. Rate of Readmission [ Time Frame: 7 days and 30 days post-hospital discharge ]
    Number of readmissions (within 7 and 30 days) to a hospital over the number of total babies

  3. Baby growth velocity [ Time Frame: From date of NICU admission until the date of NICU discharge, assessed daily up to 365 days ]
    Rate of weight gain

  4. Percent of time noise levels are within range [ Time Frame: From date of NICU admission until the date of NICU discharge, assessed daily up to 365 days ]
    Hours that noise levels are within range over total patient-time

  5. Rate of neonatal adverse events [ Time Frame: Through study completion, an average of 1 year ]
    Preventable adverse events (e.g. unplanned extubations, medication errors)

  6. Baby to parent skin-to-skin time [ Time Frame: From date of NICU admission until the date of NICU discharge, assessed daily up to 365 days ]
    Self-reported time parents are performing skin-to-skin (kangaroo care), averaged

  7. Parental Stressor Scale:Newborn Intensive Care Unit (PSS:NICU) [ Time Frame: Upon signing informed consent (baseline) and within 48 hours of discharge ]

    For NICU parents 26-item questionnaire broken down into three constructs (Parental Role Alterations, Sights and Sounds of the Unit, and Infant Behavior and Appearance) designed to measure parental perception of stressors arising from the physical and psychosocial environment of the neonatal intensive care unit.

    1. = Not at all stressful (the experience did not cause you to feel upset, tense, or anxious)
    2. = A little stressful
    3. = Moderately stressful
    4. = Very stressful
    5. = Extremely stressful Total score will be calculated by summing each item score and averaged for the group. Each subscale will also be computed by summing the items within the subscale and averaging for each group.

    Higher scores represent worse outcomes


  8. Neonatal Index of Parent Satisfaction (NIPS) [ Time Frame: Within 48 hours of discharge ]

    For NICU parents 30-item questionnaire measuring parents' satisfaction with the care their newborn child receives while in a neonatal intensive care unit (NICU).

    7-point Likert-scale (1) lowest satisfaction to (7) highest satisfaction. Sum item scores to calculate total score, with lower scores corresponding to worse outcomes.


  9. System Usability Scale (SUS) [ Time Frame: Six months after study initiation (mid-point) and 12 months after study initiation (completion) ]
    For NICU parents and clinicians 10-item questionnaire with 2 constructs: usability and learnability 5-point Likert-scale (1) strongly disagree to (5) strongly agree The participant's scores for each question added together and then multiplied by 2.5 to convert the original scores of 0-40 to 0-100. Though the scores are 0-100, these are not percentages and should be considered only in terms of their percentile ranking. Based on research, a SUS score above a 68 would be considered above average and anything below 68 is below average, however the best way to interpret your results involves "normalizing" the scores to produce a percentile ranking.

  10. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey [ Time Frame: Within 48 hours of discharge ]

    For NICU parents 7-item questionnaire assessing communication with doctors (4-items) and nurses (3-items).

    4-point Likert-scale: Never, Sometimes, Usually, Always The number of "Always" ratings for each participant is summed then divided by the number of items. The mean is then taken, stratified by group.

    Higher scores represent better outcomes.


  11. Emotional Exhaustion Scale [ Time Frame: Baseline (before study initiation), six months after study initiation (mid-point) and 12 months after study initiation (completion) ]
    For Clinicians only 4-item questionnaire about job-related frustrations. 4-point Likert-scale: (1) Disagree strongly to (5) Agree strongly. Item scores are summed and averaged by group. Higher scores represent worse outcomes.

  12. Teamwork Perceptions Questionnaire (T-TPQ) [ Time Frame: Baseline (before study initiation), six months after study initiation (mid-point) and 12 months after study initiation (completion) ]

    For Clinicians only 21-item questionnaire measuring 3 constructs: team function, mutual support, and communication 5 - Strongly Agree 4 - Agree 3 - Neutral 2 - Disagree

    1 - Strongly A total score is calculated for each teamwork construct. Summing scores in this manner allows for more accurate statistical testing.

    High scores indicate better outcomes.


  13. Frequency of Missed Care (MISSCARE) [ Time Frame: Baseline (before study initiation), six months after study initiation (mid-point) and 12 months after study initiation (completion) ]

    For Clinicians only 35-item questionnaire assessing the frequency that elements of nursing care are missed by nursing staff on the unit.

    1. - Always missed
    2. - Frequently missed
    3. - Occasionally missed
    4. - Rarely missed
    5. - Never missed Scores will be averaged per item, and a total MISSCARE score will be computed per individual by averaging all items.

    Higher scores represent better outcomes.


  14. NASA Task Load Index (NASA-TLX) [ Time Frame: Baseline (before study initiation), six months after study initiation (mid-point) and 12 months after study initiation (completion) ]

    For Clinicians only 6-item survey that rates perceived workload in order to assess the current workload in the NICU.

    Increments of high, medium and low estimates for each point results in 21 gradations on the scales assessing mental demand, physical demand, temporal demand, performance, effort, and frustration.

    Averages for each subscale will be computed. Higher scores represent worse outcomes.


  15. Percent of time light levels are within range [ Time Frame: From date of NICU admission until the date of NICU discharge, assessed daily up to 365 days ]
    Hours that light (lux) levels are within range over total patient-time


Other Outcome Measures:
  1. Incidence of Hospital Acquired Infections [ Time Frame: From date of NICU admission until the date of NICU discharge, assessed up to 365 days ]
    For example, CLABSI, Sepsis, VAP

  2. Hand washing compliance rate [ Time Frame: One year prior to study initiation, and through study completion, an average of one year ]
    Number of events found during audits

  3. Cost of care [ Time Frame: One year prior to study initiation, and through study completion, an average of one year ]
    Hospitalization costs (paid by insurance), costs/# of labs ordered, costs/# of images ordered



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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

NEONATES AND THEIR PARENTS

Inclusion Criteria:

  • Admission to the NICU
  • At least one parent (biological, guardian, or adoptive) involved
  • One parent can understand and speak the English language
  • Parent aged 14 years or older
  • Parent with sufficient mental capacity to provide written informed consent as determined by a RN
  • Signed informed consent
  • Aged 19+ yrs: Signed by parent of NICU baby
  • Aged <19 yrs (minor): signed by both parent of NICU baby and parent/guardian of parent

Exclusion Criteria:

  • Expected discharge from the NICU in <48 hours

CLINICIANS INTERACTING WITH THE NICU DASHBOARD

Inclusion Criteria:

  • Employee of institution with direct patient care in the NICU (e.g. physician, NP, RN, therapist)
  • Aged 19 years or older
  • Expected interaction with the NICU Dashboard
  • Signed informed consent

Exclusion Criteria:

  • No interaction with the NICU Dashboard

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03673566


Contacts
Contact: Amir Abdolahi, PhD, MPH 914-261-5504 amir.abdolahi@philips.com
Contact: Brian Gross, MSc, BSEE 978-659-7804 brian.gross@philips.com

Locations
United States, Nebraska
Children's Hospital and Medical Center, Omaha Not yet recruiting
Omaha, Nebraska, United States, 68114
Contact: Melissa Rice, RN, MSN    402-559-0681    mrice@childrensomaha.org   
Contact: Vanessa Le, RNC-NIC    402-955-6896    vle@childrensomaha.org   
Principal Investigator: Courtney McLean, MD, MS         
Sub-Investigator: Ann Anderson-Berry, MD, PhD         
Sub-Investigator: Nicole Birge, MD, FAAP         
Sponsors and Collaborators
Philips Healthcare
Children's Hospital and Medical Center, Omaha, Nebraska
Investigators
Principal Investigator: Courtney McLean, MD Children's Hospital and Medical Center, Omaha, Nebraska

Responsible Party: Philips Healthcare
ClinicalTrials.gov Identifier: NCT03673566     History of Changes
Other Study ID Numbers: PCMS-17-07-18.1-CHMCO
First Posted: September 17, 2018    Key Record Dates
Last Update Posted: October 3, 2018
Last Verified: October 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided
Plan Description: At this moment, Philips has no intention to share IPD with other researchers except those from institutions participating in this clinical investigation.

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Device Product Not Approved or Cleared by U.S. FDA: Yes
Pediatric Postmarket Surveillance of a Device Product: No
Product Manufactured in and Exported from the U.S.: No

Keywords provided by Philips Healthcare:
NICU
Developmental care
Neuroprotective
Technology

Additional relevant MeSH terms:
Lung Diseases
Premature Birth
Birth Weight
Respiratory Tract Diseases
Obstetric Labor, Premature
Obstetric Labor Complications
Pregnancy Complications
Body Weight
Signs and Symptoms