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Single institution experience with death by neurological criteria/brain death guideline adherence
David P Lerner1, Aleksey Tadevosyan1, Brian J Scott2
1Department of Neurology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, United States; Department of Neurology, Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, United States.
Insights
Implementing a standardized electronic medical record (EMR) checklist significantly improved adherence to death by neurologic criteria/brain death (DNC/BD) policies. This enhancement ensures more consistent application of DNC/BD protocols in clinical practice.
Area of Science:
- Neurology
- Medical Informatics
- Healthcare Policy
Background:
- Adherence to death by neurologic criteria/brain death (DNC/BD) policies is critical for accurate determination of death.
- Standardized checklists in electronic medical records (EMRs) have the potential to improve clinical workflow and adherence to protocols.
Purpose of the Study:
- To evaluate the impact of implementing a standardized DNC/BD checklist within the EMR on adherence to institutional DNC/BD policy.
- To assess the effectiveness of a digital tool in standardizing DNC/BD determination processes.
Main Methods:
- Retrospective study analyzing patients declared dead by neurologic criteria (ICD code G93.82) between June 2015 and October 2019.
- Independent review of cases for policy adherence before and after EMR checklist implementation.
- Comparison of adherence rates using unweighted kappa statistics and direct comparison of pre- and post-implementation data.
Main Results:
- A significant increase in DNC/BD policy adherence was observed, rising from 47.4% in the pre-checklist period to 94.6% in the post-checklist period (p=0.001).
- No significant differences were found in patient demographics, cause of DNC/BD, time to determination, confounders, or ancillary testing use between the two periods.
- The standardized EMR checklist demonstrated a substantial positive effect on adherence rates.
Conclusions:
- Implementation of a standardized EMR checklist is an effective strategy for substantially improving adherence to DNC/BD policies.
- Standardized digital tools can enhance the consistency and reliability of critical clinical decision-making processes.
Objective:
To determine the effect on adherence to an institutional death by neurological criteria/brain death (DNC/BD) policy of implementation of a standardized DNC/BD checklist in the electronic medical record (EMR).
Methods:
The retrospective study cohort included all patients admitted to our institution who were declared dead by neurologic criteria determined by ICD code (G93.82) between June 2015 and October 2019. Two investigators independently reviewed each case for adherence with institutional policy, and agreement was assessed using unweighted kappa statistics. Patient data and adherence to institutional policy before and after implementation of a standardized DNC/BD checklist were compared.
Results:
There were 66 patients identified by the initial search and 38 were included in the final analysis, with 19 cases in both the pre- and post- checklist periods. There were no significant differences in age, cause of DNC/BD, time to DNC/BD determination, potential toxic, metabolic, physiologic confounders, or use of ancillary testing. The pre-checklist period adherence was 47.4% (n = 9/19) versus 94.6% (n = 18/19; p = 0.001) in the post-checklist EMR DNC/BD period.
Conclusion:
Implementation of a standardized EMR checklist substantially improved DNC/BD policy adherence in our institution.
Classification Of Evidence:
This study provides Class IV evidence on the use of standardized EMR checklist to improve death by neurologic criteria/brain death policy adherence.
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