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 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 | 0.025 | 0.051 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".