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Deploying POKE Within Intermountain Healthcare

NCT ID: NCT03688607

Last Updated: 2018-09-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

2600 participants

Study Classification

OBSERVATIONAL

Study Start Date

2018-10-01

Study Completion Date

2019-05-31

Brief Summary

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To assess the impact of POKE on babies, the investigators will longitudinally track outcomes before and after implementation at Intermountain Healthcare's five NICUs. Process outcomes will include the number of total POKEs per baby and the number of painful POKEs per baby, each measured at both the patient-level and NICU-level. Clinical outcomes will include hospital acquired infections, length of stay, and mortality. Financial outcomes will include total variable costs and backfill rate. The effect of POKE on each of these outcomes will be measured using multivariable regression analysis with appropriate distributional families and interaction terms.

Detailed Description

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POKE was developed and implemented at Dixie Regional Medical Center's Neonatal Intensive Care Unit (NICU) over the past 10 years to eliminate waste and reduce harm in healthcare. POKE is a combination of a unique culture and process, with a supporting database, that is designed to guide and inform care decisions while minimizing POKEs. The program utilizes an implementation framework, educational materials, electronic health records (EHR), and decision support analytics. POKE's initial deployment showed extremely promising results for Intermountain, which included: (1) eliminating 11,000 POKEs per year (a 50% reduction in overall POKEs), (2) realizing $940,000 per year in cost savings (a 28% reduction of overall cost), (3) reducing length of stay by 2 weeks per average stay (a 21% reduction in length of stay), and (4) eliminating Hospital Acquired Infections (i.e., Central-line Associated Bloodstream Infection and Ventilator-associated Pneumonia), translating into 10 lives saved and a $5.2M savings over a decade. POKE will now be deployed and routinized within all Intermountain Healthcare NICUs and be developed as a commercial product for external customers. To assess the impact of POKE on babies, the investigators will longitudinally track several outcomes before and after implementation at Intermountain NICUs. Process outcomes will include the number of total POKEs per baby and the number of painful POKEs per baby, each measured at both the patient-level and NICU-level. Clinical outcomes will include hospital acquired infections, length of stay, and mortality. Financial outcomes will include total variable costs and backfill rate.

Conditions

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Newborn; Infection

Keywords

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NICU POKE Length of Stay Infection Neonates

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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POKE

All babies in NICU at Intermountain Healthcare hospitals

There will not be an intervention, rather the investigators will deploy best practices and track POKEs within the healthcare system to evaluate clinical and operational outcomes.

Intervention Type PROCEDURE

There will not be an intervention, rather the investigators will deploy best practices and track POKEs within the healthcare system to evaluate clinical and operational outcomes.

Interventions

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There will not be an intervention, rather the investigators will deploy best practices and track POKEs within the healthcare system to evaluate clinical and operational outcomes.

There will not be an intervention, rather the investigators will deploy best practices and track POKEs within the healthcare system to evaluate clinical and operational outcomes.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* All babies in Intermountain Healthcare NICU

Exclusion Criteria

* None
Maximum Eligible Age

12 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Intermountain Health Care, Inc.

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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R. Erick Ridout, MD

Role: PRINCIPAL_INVESTIGATOR

Intermountain Health Care, Inc.

Terri Kane, RN, MBA

Role: STUDY_DIRECTOR

Intermountain Health Care, Inc.

Brad Isaacson, PhD, MBA, MSF

Role: STUDY_DIRECTOR

Intermountain Health Care, Inc.

Locations

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Dixie Regional Medical Center, Intermountain Healthcare

St. George, Utah, United States

Site Status

Countries

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United States

Central Contacts

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R. Erick Ridout, MD

Role: CONTACT

Phone: 435-705-9208

Email: [email protected]

Terri Kane, RN, MBA

Role: CONTACT

Phone: 435-251-2104

Email: [email protected]

Facility Contacts

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R. Erick Ridout, MD

Role: primary

Patrick Carroll, MD

Role: backup

References

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Ebell MH, Sokol R, Lee A, Simons C, Early J. How good is the evidence to support primary care practice? Evid Based Med. 2017 Jun;22(3):88-92. doi: 10.1136/ebmed-2017-110704. Epub 2017 May 29.

Reference Type BACKGROUND
PMID: 28554944 (View on PubMed)

Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012 Apr 11;307(14):1513-6. doi: 10.1001/jama.2012.362. Epub 2012 Mar 14.

Reference Type BACKGROUND
PMID: 22419800 (View on PubMed)

Committee on the Learning Health Care System in America; Institute of Medicine; Smith M, Saunders R, Stuckhardt L, McGinnis JM, editors. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington (DC): National Academies Press (US); 2013 May 10. Available from http://www.ncbi.nlm.nih.gov/books/NBK207225/

Reference Type BACKGROUND
PMID: 24901184 (View on PubMed)

Special Care Nursery Admissions. (2011). National Perinatal Information Center Quality Analytic Services. Retrieved from https://www.marchofdimes.org/peristats/pdfdocs/nicu_summary_final.pdf

Reference Type BACKGROUND

Critical Care Statistics. Retrieved from http://www.sccm.org/Communications/Pages/CriticalCareStats.aspx

Reference Type BACKGROUND

Harrison W, Goodman D. Epidemiologic Trends in Neonatal Intensive Care, 2007-2012. JAMA Pediatr. 2015 Sep;169(9):855-62. doi: 10.1001/jamapediatrics.2015.1305.

Reference Type BACKGROUND
PMID: 26214387 (View on PubMed)

National Center for Health Statistics. (2018, January 31). Retrieved from https://www.cdc.gov/nchs/nvss/births.htm

Reference Type BACKGROUND

Kornhauser M, Schneiderman R. How plans can improve outcomes and cut costs for preterm infant care. Manag Care. 2010 Jan;19(1):28-30. No abstract available.

Reference Type BACKGROUND
PMID: 20131638 (View on PubMed)

Other Identifiers

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IHC IRB #1050915

Identifier Type: -

Identifier Source: org_study_id