Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Neonatal Database

PSANZ 2008 Abstract Presented

Development of an Open Source Integrated Clinical and Audit Neonatal Database
Callander I1, Kluckow M 2, NICUS3
1- Liverpool Hospital Sydney
2- Royal North Shore Hospital Sydney
3- Neonatal Intensive Care Unit Study (NSW & ACT)

NICUS data (includes ANZNN data) has been collected in a purpose built database since the beginning of 2007. This follows an extensive review of data system requirements and methodology at the National Perinatal Data System Planning Workshop in 2004. The new Neonatal Database has been constructed with minimal funding using MS SQL Data Server to house data, and MS Access as the user frontend. The system has been implemented in all 10 member tertiary hospitals with no significant cost required. Data is entered as DateTimed records where possible, using the OHIO (Observational Historical Investigations Outcomes) Principle and Audit Outcomes are then derived. NICUS Data collected since 1992 is archived in the new database and is available for comparative analysis using either the built-in reporting module (graphical outputs included) or powerful adhoc pivot table analysis from MS Excel. Data for other audits including ANZNN can be exported. The Clinical module of the Neonatal Database, is a quasi live data entry system designed to assist in day to day clinical management as well as generate discharge summaries. Initially implemented at Liverpool Hospital, this module is being progressively taken up by other units and has the functionality to manage patients as they move between hospitals. The NICUS Audit Officers have the ability to see auditable clinical data, correct it and lock it after discharge. The Neonatal Database is available for ANZNN member hospitals free of charge, however a strong case can be made for the formation of a consortium allowing for improved development. The open source model allows maximum flexibility and adaptability, but requires local IT support to implement.

Neonatal Database Screenshots:

You may enlarge the screenshots below in a new window by clicking on them.

Clinical Module:
This is the first screen after logging on and shows the current inpatient list. Babies can be moved to different bed locations from this screen. Enter the baby data screen by double clicking...
More recently a handover module has been created specifically for nursing handover and moves quickly from patient to patient with extra tools for planning and tasking.
Worksheet printout with derived clinical information plus freetext additives
Patient Data Screen: Patient descriptives along top
Current treatments, results and active problems down left side (calculated from data on the fly).
All Tabs show intially; Birth, Pregnancy and Mother Tabs are hidden by default after 3 days (they can be made visible by clicking on the perinatal summary that is generated from them)
The Jaundice Tab is hidden after 10 days (made visible by clicking on Jaundice info on left side.
Patient Data Screen looks like this after 10 days.
The Admissions Tab has 3 separate areas -
Admission: The where why and how of each admission (if multiple admissions - click on one of interest)
Planning: Future screening of brain, eyes, hearing, Immunisations, Planning of transfers
Discharge: Where to and under who's care. Followup plans and Generation of Discharge Summary (one per admission)
Respiratory diagnoses and treatments.
Respiratory support
Blood gases
Treatments with effect on respiratory system
Chest Xrays (XRay image files may be linked to these reports)
As the FiO2 and MAP/CPAP/PEEP are being changed during daily activities these values are being recorded so that they can be reviewed graphically against respiratory support / treatments by clicking on the "Graph" button on the Respiratory tab.
Growth parameters with graphing of weight and HC
Fluid intake - both intravenous and enteral
Maternal & Baby Blood Group and Coombs, causes of jaundice
Bilrubin levels (in umol/l - mg/dl would be minor change in a stored procedure)
Treatments of jaundice
Temporal graphing of Bilirubin level versus treatment against customisable gestation dependant lines for phototherapy and exchange transfusion.
Other Tab - includes Cardiac (incl echo results), Neuro (incl EEG), NEC and Freetext problems.
Problems entered as freetext are able to be datetimed to admissions, and will show on worksheets and in the discharge summary.
Treatments & Procedures
Treatments: Medications, Volume expanders and blood products, Vaccinations, Therapeutic hypothermia, Jaundice Treatments (also viewable on Jaundice tab)
Catheters: Venous & arterial lines, pleural drainage, urinary catheter Surgical Procedures (ICD-10 coded)
Test Results
Blood Tests: (these are entered manually at present, although if these were available electonically then importation would be possible
Infection screening: Multiple culture sites and organisms (pending and negative options)
Brain Imaging:Ultrasound, MRI & CT (image files may be linked to these examinations)
Eye Examinations:(retinoscope images could be easily linked as for brain images)
The Na+, Hb, WCC (Neut), Plat results can be reviewed graphically against relevant treatments by clicking on the "Graph" button on the Test Results tab.
Automated links to Image & Other files associated with patient (Files must start with MRN)
As well as having specific image files linked to XRays, Ultrasounds & MRI's you can have Images and Documents linked to a patient non-specifically
Discharge Summary
generated from the data plus freetext other problems. Created in MS Word with option for using own hospital letterhead.
Of course it is then editable for the final product. Can copy the charts from the database into windows clipboard and paste into summary if desired. The database records that the summary was generated (with audittrail)
Audit Module:
Subset of the clinical dataset is mainted at a high level of accuracy by the designated audit officer. It can be seen whether the clinical discharge summary has been completed (the notes are no longer needed)
The mode of data entry is very similar to the clinical module, but is cut down in quantity.
Respiratory and Feeding outputs are able to be seen before final closure and locking of the baby record with the generation of a new record in the audit table (calculated summary data outputs).
Followup Module:
The Followup module has been created specifically for the follow-up of premature infants according the the requirements of NICUS NSW. The list shows clinic appointments in chronological order. Assessments of Growth and Development are recorded here to enable the association of outcome data with inpatient data.
Reports Module:
As this database is capable of having data from multiple institutions (linked live OR imported) there needs to be thought about who should be able to see data from outside the users intitution. SQL server has security capabilities that make this very straight forward.
Outputs can be separated as local or pooled with other institutions.
It is also very easy to have and Excel spreadsheet that is dynamincally linked to a query within the database that allows specific reports to certain users.
Monthly Unit Report with calculated occupancy broken down by level of care.
Benchmarking between hospitals (large scale comparison of audit data)
This interface is extremely powerful and enables complicated analysis from within the module.
Of course adhoc reporting is still possible using a query analyser tool.
Line charts (customisable for Year or Gestation on X axis) also available as well as bar charts. If these charts are copied and pasted into other office applications (Word, Excel, Powerpoint) then the data is also within the object (ie not just a graphic)
Admin Module:
Update user access, hospital defaults, change lookup tables, enter SQL code (able to make backend structural changes from here) plus access to the actual tables, forms and code (if permission allows).
Electronic Logbook:
This is currently set up for medical staff to log procedures, counselling and education sessions (linked to the actual procedure within the database wherever possible). There is no reason this could be broadened to non-medical staff.
The logbook can be exported to an excel spreadsheet for transportability.
Data Queries from external applications:
It is easy to connect to the data (with permission) from outside the database. Shown here is an Excel spreadsheet that displays a PivotTable and Chart. The chart can be sent as it is to anyone however if the spreadsheet can connect to the SQL Server (with permission) then the data can be refreshed and the table manipulated; then if you double click on a grouping the individual babies can be displayed (you have to see it live to believe it).
Follow-up and Family Support Modules:
The Followup module and Family Support module have been implemented for specialised purposes and can be used as a template for those who would like to create an add-on module for themselves.
Each hospital can configure which assessment tools will be administered at their institution and make them available. The growth measures continue from the inpatient period and are graphed with centile charts against corrected age.

Certificate of Authenticity and Copyright

Obstetrix Data Import:

If your hospital uses the 'Obstetrix' database (Australia only), we have commissioned a one-way import program (perinatal data seeds a new record in the Neonatal Database) - contact Dr Martin Kluckow for details (one off payment AU$1000 required to retrieve initial outlay)

Last Updated : 5 Dec 2015
First Published : 5 Feb 2007