Evidence map›Paper›PMID 33692190›Full record

Trial reportBMJ quality & safety2021

Smart agent system for insulin infusion protocol management: a simulation-based human factors evaluation study.

Michael A Rosen, Mark Romig, Zoe Demko, Noah Barasch, Cynthia Dwyer, Peter J Pronovost, Adam Sapirstein

Open access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ quality & safety, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
0.4field-weighted citation impact, top 39% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 3 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Michael A RosenArmstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA mrosen44@jhmi.edu.ORCID 0000-0002-6621-906X
Mark RomigAnesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Zoe DemkoArmstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Noah BaraschArmstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Cynthia DwyerArmstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Peter J PronovostUniversity Hospitals of Cleveland, Shaker Heights, Ohio, USA.ORCID 0000-0002-9740-3775
Adam SapirsteinAnesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Johns Hopkins University · USUniversity Hospitals of Cleveland · US

Funding

Transdisciplinary Learning Lab to eliminate patient harm and reduce wasteP30HS023553 · AHRQ · JOHNS HOPKINS UNIVERSITY · PI SAPIRSTEIN, ADAM · 2014 to 2017
$3.9M
AHRQ HHS P30 HS023553
6 · The paper itself

Abstract

objectiveTo compare the insulin infusion management of critically ill patients by nurses using either a common standard (ie, human completion of insulin infusion protocol steps) or smart agent (SA) system that integrates the electronic health record and infusion pump and automates insulin dose selection.

designA within subjects design where participants completed 12 simulation scenarios, in 4 blocks of 3 scenarios each. Each block was performed with either the manual standard or the SA system. The initial starting condition was randomised to manual standard or SA and alternated thereafter.

settingA simulation-based human factors evaluation conducted at a large academic medical centre. SUBJECTS: Twenty critical care nurses.

interventionsA systems engineering intervention, the SA, for insulin infusion management. MEASUREMENTS: The primary study outcomes were error rates and task completion times. Secondary study outcomes were perceived workload, trust in automation and system usability, all measured with previously validated scales. MAIN

resultsThe SA system produced significantly fewer dose errors compared with manual calculation (17% (n=20) vs 0, p<0.001). Participants were significantly faster, completing the protocol using the SA system (p<0.001). Overall ratings of workload for the SA system were significantly lower than with the manual system (p<0.001). For trust ratings, there was a significant interaction between time (first or second exposure) and the system used, such that after their second exposure to the two systems, participants had significantly more trust in the SA system. Participants rated the usability of the SA system significantly higher than the manual system (p<0.001).

conclusionsA systems engineering approach jointly optimised safety, efficiency and workload considerations.

Indexed as

Infusion PumpsInsulinsComputer SimulationCritical CareHumansWorkloadInsulinshuman errorhuman factorsmedication safetynursespatient safety

Identifiers

PMID33692190
PMCPMC8543218
OpenAlexW3134365684

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.