The Experts below are selected from a list of 18018 Experts worldwide ranked by ideXlab platform
Keith F Woeltje - One of the best experts on this subject based on the ideXlab platform.
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AMIA - Development, Implementation and Use of Electronic Surveillance for Ventilator-Associated Events (VAE) in Adults.
AMIA ... Annual Symposium proceedings. AMIA Symposium, 2014Co-Authors: Ervina Resetar, Kathleen M. Mcmullen, Anthony J. Russo, Joshua A. Doherty, Kathleen A. Gase, Keith F WoeltjeAbstract:Mechanical ventilation provides an important, life-saving therapy for severely ill patients, but ventilated patients are at an increased risk for complications, poor outcomes, and death during hospitalization.1 The timely measurement of negative outcomes is important in order to identify potential issues and to minimize the risk to patients. The Centers for Disease Control and Prevention (CDC) created an algorithm for identifying Ventilator-Associated Events (VAE) in adult patients for reporting to the National Healthcare Safety Network (NHSN). Currently, the primarily manual Surveillance tools require a significant amount of time from hospital infection prevention (IP) staff to apply and interpret. This paper describes the implementation of an Electronic VAE tool using an internal clinical data repository and an internally developed Electronic Surveillance system that resulted in a reduction of labor efforts involved in identifying VAE at Barnes Jewish Hospital (BJH).
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data requirements for Electronic Surveillance of healthcare associated infections
Infection Control and Hospital Epidemiology, 2014Co-Authors: Keith F Woeltje, Michael Klompas, Marc O Wright, Gianna Zuccotti, William E TrickAbstract:Electronic Surveillance for healthcare-associated infections (HAIs) is increasingly widespread. This is driven by multiple factors: a greater burden on hospitals to provide Surveillance data to state and national agencies, financial pressures to be more efficient with HAI Surveillance, the desire for more objective comparisons between healthcare facilities, and the increasing amount of patient data available Electronically. Optimal implementation of Electronic Surveillance requires that specific information be available to the Surveillance systems. This white paper reviews different approaches to Electronic Surveillance, discusses the specific data elements required for performing Surveillance, and considers important issues of data validation.
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AMIA - Development of Electronic Surveillance for Ventilator-Associated Events (VAE) in Adults.
2013Co-Authors: Ervina Resetar, Keith F Woeltje, Kathleen M. Mcmullen, Sandra MccormickAbstract:Hospitalized patients on mechanical ventilation are at high risk for complications and poor outcomes, including death. Using Electronic health (EHR) record systems and adopting the Ventilator-Associated Events (VAE) algorithm proposed by the CDC NHSN, we are developing an algorithm for Electronic Surveillance of VAE occurring in mechanically ventilated adult patients. Results from this algorithm will be used to trend VAE, and intervene in areas with higher than expected rates.
Mark Klamberg - One of the best experts on this subject based on the ideXlab platform.
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A Paradigm Shift in Swedish Electronic Surveillance Law
Human Rights and Ethics, 2015Co-Authors: Mark KlambergAbstract:Electronic Surveillance law is subject to a paradigm shift where traditional principles are reconsidered and the notion of privacy has to be reconstructed. This paradigm shift is the result of four major changes in our society with regard to: technology, perceptions of threats, interpretation of human rights and ownership over telecommunications. The above-mentioned changes have created a need to reform both the tools of Electronic Surveillance and domestic legislation. Surveillance that was previously kept secret with reference to National Security is now subject to public debate, including Communications Intelligence (COMINT), a sub-category of Signals Intelligence (SIGINT). This chapter covers systems of “mass Surveillance,” such as data retention and COMINT, and whether these are consistent with the European Convention on Human Rights. The chapter comes to two conclusions in relation to COMINT. First, the perceived threats have changed, shifting the focus of COMINT from military threats towards non-state actors such as terrorists and criminal networks. Second, COMINT involves relatively narrow interception of the content of messages compared to its large-scale collection and storage of traffic data, which through further processing may reveal who is communicating with whom.
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The Chilling Effect of Counter-Terrorism Measures: A Comparative Analysis of Electronic Surveillance Laws in Europe and the USA
2012Co-Authors: Mark Klamberg, Elisabet FuraAbstract:Electronic Surveillance is an important tool for law enforcement and may contribute to counter-terrorism efforts. The present article examines, from a comparative privacy perspective, systems of el ...
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FRA and the European Convention on Human Rights - A Paradigm Shift in Swedish Electronic Surveillance Law
2010Co-Authors: Mark KlambergAbstract:Electronic Surveillance law is subject to a paradigm shift where traditional principles are reconsidered and the notion of privacy has to be reconstructed. This paradigm shift is the result of four major changes in our society with regard to 1) technology; 2) perceptions of threats, 3) interpretation of human rights and 4) ownership over telecommunications. The above-mentioned changes have created a need to reform both the tools of Electronic Surveillance and domestic legislation. Surveillance that was previously kept secret is now subject to public debate. The article focuses on systems of “mass Surveillance” such as data retention and signals intelligence and whether these are consistent with the European Convention on Human Rights.
Rochelle P Walensky - One of the best experts on this subject based on the ideXlab platform.
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an Electronic Surveillance tool for catheter associated urinary tract infection in intensive care units
American Journal of Infection Control, 2015Co-Authors: Erica S Shenoy, Douglas Kelbaugh, Winston Ware, Pearl Zakroysky, David C Hooper, Rochelle P WalenskyAbstract:Background Traditional methods of Surveillance of catheter-associated urinary tract infections (CAUTIs) are error-prone and resource-intensive. To resolve these issues, we developed a highly sensitive Electronic Surveillance tool. Objective To develop an Electronic Surveillance tool for CAUTIs and assess its performance. Methods The study was conducted at a 947-bed tertiary care center. Patients included adults aged ≥18 years admitted to an intensive care unit between January 10 and June 30, 2012, with an indwelling urinary catheter during their admission. We identified CAUTIs using 4 methods: traditional Surveillance (TS) (ie, manual chart review by ICPs), an Electronic Surveillance (ES) tool, augmented Electronic Surveillance (AES) (ie, ES with chart review on a subset of cases), and reference standard (RS) (ie, a subset of CAUTIs originally ascertained by TS or ES, confirmed by review). We assessed performance characteristics to RS for reviewed cases. Results We identified 417 candidate CAUTIs in 308 patients; 175 (42.0%) of these candidate CAUTIs were selected for review, yielding 32 confirmed CAUTIs in 22 patients (RS). Compared with RS, the sensitivities of TS, ES, and AES were 43.8% (95% confidence interval [CI], 26.4%-62.3%), 100.0% (95% CI, 89.1%-100.0%), and 100.0% (95% CI, 89.1%-100.0%). Specificities were 82.5% (95% CI, 75.3%-88.4%), 2.8% (95% CI, 0.8%-7.0%), and 100.0% (95% CI, 97.5%-100.0%). Conclusions Electronic CAUTI Surveillance offers a streamlined approach to improve reliability and resource burden of Surveillance.
Erica S Shenoy - One of the best experts on this subject based on the ideXlab platform.
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an Electronic Surveillance tool for catheter associated urinary tract infection in intensive care units
American Journal of Infection Control, 2015Co-Authors: Erica S Shenoy, Douglas Kelbaugh, Winston Ware, Pearl Zakroysky, David C Hooper, Rochelle P WalenskyAbstract:Background Traditional methods of Surveillance of catheter-associated urinary tract infections (CAUTIs) are error-prone and resource-intensive. To resolve these issues, we developed a highly sensitive Electronic Surveillance tool. Objective To develop an Electronic Surveillance tool for CAUTIs and assess its performance. Methods The study was conducted at a 947-bed tertiary care center. Patients included adults aged ≥18 years admitted to an intensive care unit between January 10 and June 30, 2012, with an indwelling urinary catheter during their admission. We identified CAUTIs using 4 methods: traditional Surveillance (TS) (ie, manual chart review by ICPs), an Electronic Surveillance (ES) tool, augmented Electronic Surveillance (AES) (ie, ES with chart review on a subset of cases), and reference standard (RS) (ie, a subset of CAUTIs originally ascertained by TS or ES, confirmed by review). We assessed performance characteristics to RS for reviewed cases. Results We identified 417 candidate CAUTIs in 308 patients; 175 (42.0%) of these candidate CAUTIs were selected for review, yielding 32 confirmed CAUTIs in 22 patients (RS). Compared with RS, the sensitivities of TS, ES, and AES were 43.8% (95% confidence interval [CI], 26.4%-62.3%), 100.0% (95% CI, 89.1%-100.0%), and 100.0% (95% CI, 89.1%-100.0%). Specificities were 82.5% (95% CI, 75.3%-88.4%), 2.8% (95% CI, 0.8%-7.0%), and 100.0% (95% CI, 97.5%-100.0%). Conclusions Electronic CAUTI Surveillance offers a streamlined approach to improve reliability and resource burden of Surveillance.
H. L. Wald - One of the best experts on this subject based on the ideXlab platform.
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Accuracy of Electronic Surveillance of Catheter-Associated Urinary Tract Infection at an Academic Medical Center
Infection Control & Hospital Epidemiology, 2014Co-Authors: H. L. Wald, B. Bandle, Angela A. Richard, Sung-joon MinAbstract:Objective. To develop and validate a methodology for Electronic Surveillance of catheter-associated urinary tract infections (CAUTIs).Design. Diagnostic accuracy study.Setting. A 425-bed university hospital.Subjects. A total of 1,695 unique inpatient encounters from November 2009 through November 2010 with a high clinical suspicion of CAUTI.Methods. An algorithm was developed to identify incident CAUTIs from Electronic health records (EHRs) on the basis of the Centers for Disease Control and Prevention (CDC) Surveillance definition. CAUTIs identified by Electronic Surveillance were compared with the reference standard of manual Surveillance by infection preventionists. To determine diagnostic accuracy, we created 2 × 2 tables, one unadjusted and one adjusted for misclassification using chart review and case adjudication. Unadjusted and adjusted test statistics (percent agreement, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and κ) were calculated.Results. Ele...
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Accuracy of Electronic Surveillance of Catheter-Associated Urinary Tract Infection at an Academic Medical Center
Infection Control & Hospital Epidemiology, 2014Co-Authors: H. L. Wald, B. Bandle, A. Richard, S. MinAbstract:Objective.To develop and validate a methodology for Electronic Surveillance of catheter-associated urinary tract infections (CAUTIs).Design.Diagnostic accuracy study.Setting.A 425-bed university hospital.Subjects.A total of 1,695 unique inpatient encounters from November 2009 through November 2010 with a high clinical suspicion of CAUTI.Methods.An algorithm was developed to identify incident CAUTIs from Electronic health records (EHRs) on the basis of the Centers for Disease Control and Prevention (CDC) Surveillance definition. CAUTIs identified by Electronic Surveillance were compared with the reference standard of manual Surveillance by infection preventionists. To determine diagnostic accuracy, we created 2 × 2 tables, one unadjusted and one adjusted for misclassification using chart review and case adjudication. Unadjusted and adjusted test statistics (percent agreement, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and κ) were calculated.Results.Electronic Surveillance identified 64 CAUTIs compared with manual Surveillance, which identified 19 CAUTIs for 97% agreement, 79% sensitivity, 97% sensitivity, 23% PPV, 100% NPV, and κ of .33. Compared with the reference standard adjusted for misclassification, which identified 55 CAUTIs, Electronic Surveillance had 98% agreement, 80% sensitivity, 99% specificity, 69% PPV, 99% NPV, and κ of .71.Conclusion.The Electronic Surveillance methodology had a high NPV and a low PPV compared with the reference standard, indicating a role of the Electronic algorithm in screening data sets to exclude cases. However, the PPV markedly improved compared with the reference standard adjusted for misclassification, suggesting a future role in Surveillance with improvements in EHRs.Infect Control Hosp Epidemiol2014;35(6):685–691
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Implementation of Electronic Surveillance of catheter use and catheter-associated urinary tract infection at Nurses Improving Care for Healthsystem Elders (NICHE) hospitals.
American Journal of Infection Control, 2014Co-Authors: H. L. Wald, B. Bandle, Angela A. Richard, Sung-joon Min, Elizabeth CapezutiAbstract:Background Manual Surveillance of indwelling urinary catheters (IUCs) and catheter-associated urinary tract infections (CAUTIs) is resource intense. Methods We implemented Electronic Surveillance in nonintensive care units of Nurses Improving Care for Healthsystem Elders (NICHE) hospitals. Capacity was created centrally to analyze data collected Electronically or manually at each site. We measured the average IUC duration and proportion of patients with IUC duration Results Electronic Surveillance was implemented in 25 units at 20 NICHE hospitals. Full automation was achieved at 15 of 16 sites with Electronic health records (EHRs). Electronic Surveillance challenges included EHR data element formats and IUC documentation. Study units reported on 4,574 patients for 16,105 IUC days over a 6-month period. The mean of the unit-level average IUC duration was 3.2 ± 2.6 days, mean proportion of patients with IUC duration Conclusion A centralized Electronic Surveillance strategy for CAUTI is feasible and sustainable. Baseline performance of participating sites was exemplary, with very low SIRs at baseline.
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Implementation of Electronic Surveillance of catheter use and catheter-associated urinary tract infection at Nurses Improving Care for Healthsystem Elders (NICHE) hospitals.
American journal of infection control, 2014Co-Authors: H. L. Wald, B. Bandle, Angela A. Richard, Sung-joon Min, Elizabeth CapezutiAbstract:Manual Surveillance of indwelling urinary catheters (IUCs) and catheter-associated urinary tract infections (CAUTIs) is resource intense. We implemented Electronic Surveillance in nonintensive care units of Nurses Improving Care for Healthsystem Elders (NICHE) hospitals. Capacity was created centrally to analyze data collected Electronically or manually at each site. We measured the average IUC duration and proportion of patients with IUC duration <3 days. CAUTIs were identified using a validated algorithm based on the Centers for Disease Control and Prevention definition and used to calculate rates and standardized incidence ratios (SIRs). Electronic Surveillance was implemented in 25 units at 20 NICHE hospitals. Full automation was achieved at 15 of 16 sites with Electronic health records (EHRs). Electronic Surveillance challenges included EHR data element formats and IUC documentation. Study units reported on 4,574 patients for 16,105 IUC days over a 6-month period. The mean of the unit-level average IUC duration was 3.2 ± 2.6 days, mean proportion of patients with IUC duration <3 days was 52.4% ± 50%, and mean CAUTI SIR was 0.14 ± 0.31. A centralized Electronic Surveillance strategy for CAUTI is feasible and sustainable. Baseline performance of participating sites was exemplary, with very low SIRs at baseline. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
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A Trial of Electronic Surveillance feedback for quality improvement at Nurses Improving Care for Healthsystem Elders (NICHE) hospitals.
American Journal of Infection Control, 2014Co-Authors: H. L. Wald, B. Bandle, Angela A. Richard, Sung-joon Min, Elizabeth CapezutiAbstract:Background Catheter-associated urinary tract infection (CAUTI) risk is directly related to duration of indwelling urinary catheters (IUCs), rising beyond 2 days of catheterization. Methods We conducted a cluster randomized study in nonintensive care units of Nurses Improving Care for Healthsystem Elders (NICHE) hospitals. Electronic Surveillance data were used in an audit and feedback intervention for frontline nurses to reduce IUC duration. Multivariable methods were used to identify the difference in average IUC duration and proportion of patients with IUC duration Results A total of 24 units at 19 NICHE hospitals reported 13,499 adult patients with IUCs over 18 months. Early and delayed intervention groups had important baseline differences in IUC utilization. Use of evidence-based CAUTI prevention measures increased during study participation. In multivariable analysis, the average IUC duration and proportion of patients with IUC duration Conclusion The impact of the audit and feedback intervention was not significant despite the uptake of evidence-based CAUTI prevention practices.