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Intensive care
Research
Lessons learnt during the implementation of a web-based triage tool for Dutch intensive care follow-up clinics
  1. Ilse van Beusekom1,2,
  2. Ferishta Bakhshi-Raiez1,2,
  3. Nicolette F de Keizer1,2,
  4. Dave A Dongelmans3,
  5. Marike van der Schaaf4,5
  1. 1 Academic Medical Center, Department of Medical Informatics, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
  2. 2 National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands
  3. 3 Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  4. 4 Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
  5. 5 Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
  1. Correspondence to Ilse van Beusekom; i.vanbeusekom{at}amc.uva.nl

Abstract

Objectives Screening for symptoms of postintensive care syndrome is based on a long list of questionnaires, filled out by the intensive care unit (ICU) survivor and manually reviewed by the health professional. This is an inefficient and time-consuming process. The aim of this study was to evaluate the feasibility of a web-based triage tool and to compare the outcomes from web-based questionnaires to those from paper-based questionnaires.

Design A mixed-methods study.

Setting Nine Dutch ICU follow-up clinics.

Participants 221 ICU survivors and 14 health professionals.

Interventions A web-based triage tool was implemented by nine ICU follow-up clinics. End users, that is, health professionals were interviewed in order to evaluate the feasibility of the triage tool. ICU survivors were invited to fill out web-based questionnaires 3 months after hospital discharge.

Primary outcomes Outcomes of the questionnaires were merged with clinical data from a national quality registry to assess the differences in outcomes between paper-based and web-based questionnaires.

Results 221 ICU survivors received an invitation to fill out questionnaires, 93 (42.1%) survivors did not respond to the invitation. Respondents to the web-based questionnaires (n=54) were significantly younger and had a significantly longer ICU stay than those who preferred the paper-based questionnaires (n=74). The prevalence of mental, physical and nutritional problems was high, although comparable between the groups. Health professionals’ interviews revealed that the software was complex to use (n=8) and although emailing survivors is very convenient, not all survivors have an email address (n=7).

Conclusions Web-based screening software has major benefits compared with paper-based screening. However, implementation has shown to be rather difficult and there are important barriers to consider. Although different in age, the health status is comparable between the users of the web-based questionnaire and paper-based questionnaire.

  • health informatics
  • information management
  • world wide web technology
  • organisational development

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2017-021249

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    Footnotes

    • Contributors IvB gave the training to use the triage tool, conducted all semistructured interviews with the health professionals, transcribed the interviews verbatim, coded the interviews and drafted the manuscript. FB-R gave the training to use the triage tool, coded the interviews and helped to draft the manuscript. NFdK participated in the design and coordination of this study. DAD helped in analysing and interpreting the results. MvdS participated in the design and coordination of this study. All authors discussed the themes and statements of the coding, read and approved the final manuscript.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The NICE registry is registered according to the Dutch Personal Data Protection Act. The need for ethical approval for this study was waived by the Medical Ethics Committee of the Academic Medical Center and stored under number W17-354.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement We obtained permission from the research board of the NICE registry and the participants to use data at the time of the study. The NICE board assesses each application to use the data on the feasibility of the analysis and whether or not the confidentiality of patients and ICUs will be protected. To protect confidentiality, raw data from ICUs are never provided to third parties. For the analyses described in this paper, we used an anonymised dataset. The use of anonymised data does not require informed consent in the Netherlands.