Abstract 20397: Linking Improved Processes of Care With Timeliness of Intravenous Diuresis for Acute Heart Failure
Bibliographic record
Abstract
Background: Intravenous administration of loop diuretics is a cornerstone of therapy for acute heart failure. We developed the MSH La6 Protocol, a tool to standardize practices for administration, monitoring and dose adjustment of IV furosemide over a 48-hour period. The tool also delegated autonomy to the nurse at the point of care to conduct all actions associated with the La6 Protocol, with the intent of minimizing delays arising from frequent consultation with ordering physicians. The safety and impact of this initiative on markers of quality heart failure care and timeliness of furosemide administration were evaluated. Methods: A pre- and post-implementation time series study analysis was performed. The primary process measure was adherence to daily monitoring of patients receiving IV loop diuretics and was evaluated using composite opportunity and all-or-none scores as well as Shewhart control charts. Outcome measures consisted of the doses of furosemide administered in the first 48 hours of admission to hospital, separated into two 24-hour blocks. Incidence of hypokalemia and increase in serum creatinine as evidence of AKI were evaluated as markers of safety. Results: Between the pre (32 months, n=338) and post (8 months, n=121) implementation period, a significant and stable improvement was observed in the opportunity-based composite score from a mean of 82% to 90% and the all-or-none score from 30% to 57% using Shewhart control charts. Within the pre-implementation cohort, the mean furosemide dose significantly decreased between the 0-24 and 24-48h time block, while no such change was observed within the post-implementation cohort. A significantly larger proportion of patients treated using the La6 Protocol had a dose increase in the 24-48 hour block versus patients treated with usual care. There were no serious adverse events and no deaths. There was no increase in the incidence of hypokalemia or evidence of AKI in the post-implementation cohort. Conclusions: An intervention that resulted in improved adherence to practices for monitoring was also associated with the observation that furosemide dosage was up titrated more frequently early during hospital admission.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".