The adaptation and utilisation of a best-of-breed informatics system to support safe operational expansion during the COVID19 epidemic in a London University hospital at the UK outbreak epicentre

Introduction: Best of breed informatics systems have an unclear evidence base for delivering clinically efffective support over paperbased systems or large institutional electronic health records (Rubenfeld, 2004;Morrison, 2008) During the COVID 19 pandemic, King's College Hospital admitted over 2000 patients with COVID 19, 190 of whom required an admission for critical care Severity in our population was higher than seen in other UK centres, in part due to the high incidence of renal failure (50%) We assessed the use and effectiveness of a best-of-breed critical care informatics system in this unprecedented period of operational and clinical strain Objectives: To use SQL reports and general database to assess the scope and effectiveness of a rapid electronic/informatics systems expansion during the COVID 19 pandemic in a central London critical care service Methods: The configuration of the ICCA system was compared post COVID 19 to that pre-COVID 19 In addition, pre-existing and new ad hoc SQL queries were constructed from the Intellivue, Critical Care & Anaesthesia Informatics System (ICCA, Philips HealthCare) database using Sequel Server Management Studio 17 These were used to assess changes to configuration and workflow support;activity;electronic workflow alerts and adverse event capture Results: The ICCA informatics support system was rapidly expanded from 51 to 196 licensed support beds, including Census Page and Dashboard expansions Over the pandemic period 1022 healthcare professionals were added to the system users database 506 additional client computers were also added Remote service review was set up for anaesthesia, renal, cardiology, diabetes, haematology and nutrition teams The system and systems team provided a bespoke pathophysiological flowsheet and designed three clinical reports to support strategic mangement of overall clinical operations, renal replacement and airway management 29 major urgent prescription changes were delivered to reflect supply chain breakdown and the need to deliver new COVID 19 trials This included changes to sedation regimens, muscle relaxants, fluids and electrolyte replacement There were also several hundred individual text changes to prescription/administration of medications to support the major category updates System screening was used to issue 1288 workflow support alerts during the pandemic period Commonest alerts were around sedation levels;ventilator driving pressure;patient allergies and patient identity Importantly, several operationally important system updates were developed A visual basic solution was written to provide a physical paper medication chart to go with the patient at discharge and the servers received improved power redundancy to decrease downtime Finally, the system captured 159 adverse incidents that were not reported in the institutional 'Datix' system Conclusion: We have described the rapid and effective expansion of a critical care informatics system from 51 beds to 196 beds during the COVID 19 pandemic response of a large critical care service The level of rapid adaptation may not have been possible on paper or across an institutional EHR