Table 3.
Key display features and study outcomes according to information display category
| Type | Citation | Design | Key Features | Primary endpoint(s) | Result(s) | Effect |
|---|---|---|---|---|---|---|
| Comprehensive | Dziadzko et al, 201626 | Pre-post | High-value data, extracted from the EMR, are organized by clinical concept and displayed in patient-centered viewers; additional information including interventions, laboratory data, problem lists, and notes can be accessed; urgency of clinical problems displayed by color. | Satisfaction: User | Improved satisfaction in 13 of 15 questions compared with EHR functionality (P < .05). | Positive |
| Pickering et al, 201537 | RCT | Efficiency: Time spent on pre-round data gathering per patient | Decreased time from 12 to 9 min (P = .03). | Positive | ||
| Hoskote et al, 201727 | Pre-post | Process: Percentage agreement in tasks | No significant difference: 24.6% pre vs 31.3% post (P = .1). | Neutral | ||
| Olchanski et al, 201728 | Pre-post | Patient Outcome: ICU mortality | No significant difference: 4.6% pre vs 3.4% post (P = .33). | Positive | ||
| Patient Outcome: Length of stay in ICU | Decreased length of stay: 4.1 d pre vs 2.5 d post (P < .0001) | |||||
| Kheterpal et al, 201829 | Pre-post | AlertWatch OR: real-time data extraction from physiologic monitors and EHR displayed in schematic “live” view of organ systems, color, text, and audible alerts. | Patient Outcome: Time MAP <55 mm Hg (hypotension) | Decreased: 2 min AlertWatch vs 1 min parallel control vs 1 min historical control (P < .001) | Positive | |
| Process Outcome: Inappropriate ventilation | Decreased: 28% AlertWatch vs 37% parallel control vs 57% historical control (P < .001) | |||||
| Process Outcome: Median crystalloid infused (fluid resuscitation rate) | Decreased: 5.88 mL·kg–1·h–1 AlertWatch vs 6.17 mL·kg–1·h–1 parallel control vs 7.40 mL·kg–1·h–1 historical control (P < .001) | |||||
| Jiang et al, 201730 | Pre-post | Electronic handoff tool with labeled free-text boxes for data entry; printout version includes the Handoff Tool and EHR data, such as medication orders and laboratory results. | Process: Mean content overlap index | No difference: 0.06 pre vs 0.06 post (P = .75) | Neutral | |
| Process: Mean discrepancy rate per hands-off group | No significant difference: 0.76 pre vs 1.17 post (P = .17) | |||||
| Multipatient dashboards | Shaw et al, 201520 | Pre-post | Unit-wide dashboard displays noncompliant patients for a set of safety measures. | Process: Median time from ICU admission to treatment consent | No significant difference at preimplementation (393 min), 1 mo postimplementation (304 min), and 4 mo post implementation (202 min) (P = .13). | Neutral |
| Pageler et al, 201425 | Pre-post | Patient-specific, EHR-enhanced checklists, educational information on bundle items, and a unit-wide safety and quality dashboard. Color used to indicate noncompliant. | Process: Compliance with CLABSI prevention bundle (5 elements) | Increased compliance with daily documentation of line necessity (from 30% to 73%; P < .001); dressing changes (from 87% to 90%; P = .003); cap changes (from 87% to 93%; P < .001); and port needle changes (from 69% to 95%; P < .001). Decreased compliance with insertion bundle documentation (from 67% to 62%; P = .001). | Positive | |
| Patient outcome: Rate of CLABSI | Decreased rates from 2.6 to 0.7 per 1000 line-days (P = .03). | |||||
| Lipton et al, 201121 | Pre-post | Current glucose levels and trends for multiple patients along with protocol advice for insulin dosage. | Process: Compliance with glucose measurement time | Increased compliance from 40% to 52% (P < .001) | Positive | |
| Zaydfudim et al, 200923 | Pre-post | Multipatient dashboard of ventilator bundle compliance, ventilator status, deep venous thrombosis, and stress ulcer prophylaxis. Color used to indicate noncompliant. | Patient outcome: Rate of VAP | Reduced rates from 15.2 to 9.3 per 1000 ventilator d (P = .01). | Positive | |
| Bourdeaux et al, 201631 | Pre-post | Dashboard with visual cues for high TVes; multipatient display screens (mounted on the wall at either end of the ICU) showed red when TVe >8 and yellow when TVe >6. | Process outcome: Time it takes the TVe values to drop below threshold | Decreased time: 4.2 h pre, 1.4 h post year 1, 0.95 h post year 2, 0.66 h post year 3 | Positive | |
| Cox et al, 201832 | Pre-post | Clinicians can access a dashboard that allows them to view a list of patients meeting automated palliative care triggers, approve a palliative care consult for any patient on the list, and review family-completed palliative care needs assessments adapted from the needs of the social nature, existential concerns, symptoms, and therapeutic interaction (NEST) scale. | Process: Mean ICU days before palliative care consult | No difference: 3.6 d Intervention vs 6.9 d Control A (P = .21) | Mixed | |
| Process: Mean ICU days after palliative care consult | No difference: 4.4 d Intervention vs 5.1 d Control A (P > .05) | |||||
| Process: Mechanical ventilation days after palliative care consult | No difference: 7 d Intervention vs 9 d Control A (P > .05) | |||||
| Secondary outcome: NEST total unmet needs score | Improved: Decrease in Intervention of 12.7 units vs Increase in Control B of 3.4 units (P = .002) | |||||
| Fletcher et al, 201840 | N-Cohort | Customizable list of patients showing risk of decompensation and composite calculations based on vital signs and laboratory results including (1) a rapid response score and (2) a modified early warning score; scores are color coded to show 3 levels of risk severity. | Process: Number of first rapid response team activations | Significant increase: 71.5 while the display was off vs 86.0 while the display was on per 1000 admissions (IRR, 1.20; P = .04) | Positive | |
| Process: Number of unexpected ICU transfers | No difference: 117 while the display was off vs 145 while the display was on (IRR, 1.15; P = .25) | |||||
| Physiologic and laboratory monitoring | Giuliano et al, 201224 | Pre-post | Horizon Trends displays baseline target and range for any physiological parameter. ST Map highlights ST changes in ECG | Patient outcome: Mean arterial pressure | Increased MAP from 63.7 to 68.1 mm Hg (P = .004) | Positive |
| Patient outcome: % of time MAP levels were within target levels | Increased from 72.8% to 76.3% (P = .031) | |||||
| Sondergaard et al, 201233 | RCT | Graphical and numeric display of patient parameters and targets | Patient outcome: Mean percentage time MAP and CO in target zone averaged standardized difference | No difference: 36.7 (95% CI, 24.2%-49.2%) vs 36.5% (95% CI, 24.0%-49.0%) | Neutral | |
| No difference, 1.5 (range, 1.1–2.3) vs 1.6 (range, 1.2–2.6). | ||||||
| Kennedy et al, 201039 | N-cohort | Anesthetic uptake model that predicts end-tidal sevoflurane and isoflurane concentrations | Patient outcome: Time to change in Ceff levels of sevoflurane | No difference, 220 vs 227 s (95% CI for the difference, –51 s to 32 s) | Neutral | |
| Kennedy et al, 200438 | N-cohort | Patient outcome; Time to change in end-tidal sevoflurane | Changes made on average 1.5–2.3 times faster (P < .05). | Positive | ||
| Kirkness et al, 200835 | RCT | Bars of CPP trend in different colors based on a threshold of 70 mm Hg and numeric display of current CPP. | Patient outcome: GOSE exam 6 months after injury | No difference, 4.16 vs 4.37 (P = .42) | Neutral | |
| FSE 6 months after injury | No difference, 19.78 vs 18.88 (P = .45) | |||||
| Kirkness et al, 200634 | RCT | Patient outcome: GOSE score 6 months after injury | No difference, 4.13 vs 3.82 (P = .389) | Mixed | ||
| FSE score 6 months after injury | No difference, 18.46 vs 19.02 (P = .749) | |||||
| Secondary outcome: improved odds of survival at discharge | Odds ratio, 3.82 (95% CI, 1.13–12.92; P = .03). | |||||
| Bansal et al, 200119 | Pre-post, parallel control | Patient ABG results graphed over time; color shading indicated abnormally high or low values; order entry for ABG ordered to promote less ordering and includes a variety of timing/urgency options | Cost: Ratio of number of ABG tests processed between intervention and control units | Nonsignificant ratio after adjusting for temporal variation in linear regression model (P = .55) | Neutral | |
| Expert system | Semler et al, 201536 | RCT | Integrated sepsis management tool | Process outcome: Time from enrollment to completion of all items on 6-hour sepsis resuscitation bundle | No difference: hazard ratio, 1.98 (95% CI, 0.75–5.20; P = .159) | Neutral |
| Evans et al, 199522 | Pre-post | Integrated display of infection parameters and antibiotic use recommendations | Cost: Average antibiotic per patient | Decreased from $382.68 to $295.65 (P < .04) | Positive |
Outcomes were rated positive if any primary outcome significantly improved, mixed if any secondary but not primary outcomes significantly improved, and neutral if no difference was observed—no studies found an overall negative impact.
ABG: arterial blood gas; Ceff: estimates of past and future effect site; CI: confidence interval; CLABSI: central line–associated blood stream infection; CO: cardiac output; CPP: cerebral perfusion pressure; ECG: electrocardiogram; EHR: electronic health record; FSE: Functional Status Examination; GOSE: Extended Glasgow Outcome Scale; ICU: intensive care unit; IRR: incidence rate ratio; MAP: mean arterial pressure; RCT: randomized controlled trial; TVe: tidal volume; VAP: ventilator-associated pneumonia.