Implementation and sustainability of an innovative ICU e-diary
Bibliographic record
Abstract
OBJECTIVES: To characterise e-diary implementation exploring ICU staff uptake, family member engagement, perceived barriers/facilitators and perceived acceptability/feasibility and sustained use over time. METHODS: Service innovation and evaluation study of an e-diary (aTouchAway™, Aetonix, Canada) for patients with ≥ 2 days anticipated ICU stay. We implemented (Jan2022-Aug2022) in four ICUs (52 beds) across two UK hospitals. We conducted a one-day pre-implementation paper-diary snapshot audit. Implementation strategies included a dedicated implementation officer, repeated education, dedicated resources, completion reminders, live demonstrations, and e-diary completion prizes. We collected data on commencement rates, barriers/facilitators, and feasibility/acceptability using Acceptability and Feasibility of Intervention Measure (AIM/FIM) questionnaires. To assess sustained use, we completed three one-day audits (June2023), with subsequent monthly audits (Dec2023-Dec2024). RESULTS: Pre-implementation, 7/35 (20%) patients had a paper diary. During the implementation phase the monthly mean (SD) e-diary commencement rate was 65% (23%) with 380 patients having 1242 diary entries (nurses 807; therapists (physio/occupational/speech) 146; family members 289). We received 35/110 staff questionnaires (response rate 32%). Most perceived the e-diary easy to access (74%) and use (63%). Similar proportions perceived it less (20%) or more (26%) time consuming than paper diaries. Facilitators included reduced environmental impact, negligible loss, family participation, guaranteed legibility, data security, and easy accessibility. Barriers comprised need for login and education; difficulty for less technologically-competent families; and inability to personalise with pictures. Mean (SD) AIM and FIM scores were 16.6 (1.67) and 16.0 (1.9). In the sustainability phase, our snapshot audit (June2023) found a commencement rate of 63%, with a mean (SD) monthly commencement rate of 45.6% (16.7%). CONCLUSIONS: We developed a bespoke e-diary with moderate yet sustained implementation success. We identified facilitators to be harnessed by other centres considering e-diary implementation. Although some barriers are non-modifiable, strategies can support family members to engage. IMPLICATIONS FOR CLINICAL PRACTICE: For centres considering e-diary adoption, they appear an acceptable alternative with facilitators that can be harnessed to promote adoption but barriers that need consideration.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".