Epimed to assist critical care
research
Jorge Salluh
Intensive care dept, Instituto D’Or de Pesquisa e Ensino
Founder Epimed Solutions
Researcher FAPERJ and CNPq
BRICNet – Brazilian Research in Intensive Care Network
Paris, 2017
Conflicts of Interest
Founder and shareholder at Epimed Solutions
A quick overview
Critical Care in Brazil
Salluh & Lisboa, ICU management, 2016
A quick overview
Critical Care in Brazil
Salluh & Lisboa, ICU management, 2016
Distribution of ICU beds
Brasil - private
Brasil - public
Salluh & Lisboa, ICU management, 2016
Some Landmarks for critical care in Brazil
1998 – Ministry of Health regulations determine that all
adult ICUs must calculate Standardized Mortality Ratios
2009 - Brazilian Critical Care Society (AMIB) establish its
updated (second) set of quality of care standard metrics.
2010 – Governmental regulatory agency (ANVISA)
establishes 11 quality of care indicators that must be
recorded by every adult ICU in the country
2015 – Epimed and AMIB establishes the National ICU
registry based on Epimed ICU module data
Challenges
Develop and implement a QI program
Ability to collect data in a large scale
Heterogeneous adoption of EMRs
Need to make not only data collection, but QI
feasible in real world scenario
What is Epimed Monitor ?
Cloud-based quality improvement ICU analytics
Brazilian company founded in 2008 by ICU
physicians
Focus on QI, Epidemiology, advanced analytics and
research
Answers to the Challenge
Multiplatform easy to use interface
Full Cloud Solution (Safe, Privacy secured, Encrypted, Anonimyzed)
Real-time reports and Interactive Dashboards
Clear Definition of Core data, additional QI data, Checklists and Bundle
plugins to be adopted as stand-alone or to allow a stepwise implementation
Fully exportable dataset and reports in
friendly format
Monthly Local meetings + National
annual meeting for feedback and training
Premises
Light and easy to use
Mobile compatible
Able to interface with EMRs
Real-Time availability of information as a driver of
CHANGE (data on Process/Outcomes)
Accessible and up to date (near-real-time/ real-time)
Benchmarking
Landmarks of our Project
2015
Brazilian
Registry
Beginning
of
activities
in
Colombia
2011
134
Hospital
s 203
ICUs
2728
Beds
2008
5
ICUS
2
Citie
s
2009
49
Hospitals
69 ICUs
759 Beds
End of
2014
600 ICUs
8200 Beds
1 Million
patients
Partership
with AMCI
(Colombia
Crit Care
Society)
Activities
in Uruguay
Epimed in numbers (2017)
EPIMED MONITOR
 5 Countries
 180 Cities
 400 HOSPITALS
 800 ICUs
 11.000 ICU beds
 1.500.000 ICU
admissions
What makes Epimed a hub for research ?
11,000 users (ICU physicians and Nurses)
Structured core data on clinical characteristics,
outcomes and process of care
Real-time reports
+ 30,000 adult ICU admissions/month
 A robust database for cohort studies;
 Validated in single and multicenter international studies in intensive
care;
 Potential to identify patients for clinical trial entry
 More than 20 publications (abstracts and full-papers) per year use and
cite Epimed Monitor;
 Some studies in major Journals that used Epimed as database:
 Crit Care. 2010;14(6):R210. doi: 10.1186/cc9333
 Crit Care. 2013 Apr 4;17(2):R63. doi: 10.1186/cc12594
 Crit Care. 2014 Jul 21;18(4):R156. doi: 10.1186/cc13995.
 Ann Oncol. 2014 Sep;25(9):1829-35. doi: 10.1093/annonc/mdu234
 Crit Care. 2014,18:580 doi:10.1186/s13054-014-0580-3
 Intensive Care Med. 2015 Dec;41(12):2149-60.
 JAMA. 2016 Apr 12;315(14):1480-90.
 J Clin Oncol. 2016 Sep 20;34(27):3315-24.
 Intensive Care Med. 2017 Jan;43(1):39-47
Knowledge on Epidemiology to
design RCTs and Govt Projects
Sample Size Calculation for Observational Studies and
RCTs recently published in Top Journals (ex-JAMA. 2016
Apr 12;315(14):1480-1490)
Background information to design and apply for Grant
propositions (ie- Recent wellcome trust and Gates
foundation applications; BASICS trial)
Information on Sepsis Mortality for the Brazilian MOH
sepsis project
Epidemiology and Cohort studies
Delirium epidemiology in critical care (DECCA): an
international study
Delirium is
frequent (32-65%)
and doubles the
risk of death.
Preventable
causes were
identified and led
to QI projects
Crit Care. 2010;14(6):R210.
Early Sedation and Outcomes in Mechanically Ventilated Patients (Crit
Care. 2014 Jul 21;18(4):R156)
Early
oversedation is
associated with
worst outcomes
and is a target for
QI initiatives
Quality Improvement studies
Implementation of a multifaceted sepsis education program in an
emerging country setting: clinical outcomes and cost- effectiveness in a
long-term follow-up study
Noritomi et al, Intensive Care Med (2014) 40:182–191
12 Hospitals in Sao Paulo implemented electronic-driven bundles and sepsis
case management for 18 months – a before-and-after study
Evaluation of a minimal sedation protocol using ICU sedative
consumption as a monitoring tool: a quality improvement multicenter
project
Ranzani et al. Critical Care 2014, 18:580
10 Hospitals in Sao Paulo implemented electronic-driven and pharmacist
management of sedative consumption for 2– a before-and-after study
resulted in decreased sedative consumption and MV days
Optimizing the connection between researchers…
The ORCHESTRA (ORganizational
CHaractEriSTics in cRitical cAre) Study
THE ORCHESTRA studies
78 Brazilian intensive care units: the ORCHESTRA
study.
Data from 2013
60,000 ICU patients
Surveys on Structure and Process of Care
THE ORCHESTRA studies
Organizational characteristics, outcomes, and resource use in 78
Brazilian intensive care units: the ORCHESTRA study.
(Intensive Care Med. 2015 Dec;41(12):2149-60)
Effects of Organizational Characteristics on Outcomes and Resource Use
in Patients With Cancer Admitted to Intensive Care Units. (J Clin Oncol.
2016 Sep 20;34(27):3315-24.)
The effects of performance status one week before hospital admission on
the outcomes of critically ill patients. (Intensive Care Med. 2017
Jan;43(1):39-47)
Family care, visiting policies, ICU performance, and efficiency in resource
use: insights from the ORCHESTRA study. (Intensive Care Med. 2017 , in
press)
5 additional papers being drafted
THE ORCHESTRA 2...so far
92 Brazilian intensive care units
+ 1500 ICU beds
Data from 2014 and 2015
130,000 ICU patients
International Collaboration
Current research collaborations with…
ICNARC –UK – Improving Sepsis Reporting
Characteristics and Outcomes Project
MIMIC-II USA/ANZICS-CORE – Global open
source Scoring system development study
Conclusions
 Epimed is currently one of the largest systems for
quality improvement and ICU performance
management and opens interesting possibilities for
ICU research in a large and well-structured database
 There is a great potential for studies on both highly
frequent/relevant ICU topics as well as rare diseases