EXECUTIVE SUMMARY 1 Executive Summary: Digital Chest Drainage Systems in the CVIU Larrin Bryant College of Nursing, East Carolina University Dr. Mark Hand Doctor of Nursing Practice EXECUTIVE SUMMARY 2 Executive Summary: Digital Chest Drainage Systems in the CVIU Main Points • Implementation of a two-phase process to educate and train nurses, over 12 weeks, on the functionality and operational instruction for digital chest drainage devices and monitoring the device use in pulmonary lung resection patients • 18 patients used the device during a 9-week monitoring phase • No profound difference in reduced length of stay for patients using the digital device system when compared to the analog system • Digital systems have features that benefit both the nurse and patient including improved efficiency of nurse workflow, safe patient ambulation, and enhanced accuracy of measurement data • Several limitations were noted including small sample size, device damage, and magnetic resonance imaging (MRI) incompatibility • Recommendations for future investigation with longer duration of data collection, evaluation of cost savings analysis, and feedback on patient experience Background and Purpose Digital healthcare technology has the capability of improving the quality of treatments and services for patients and enhancing the efficiency of nursing care workflow (Stoumpos et al., 2023). Digital chest tube drainage systems are at the forefront of this technology aiding in the recovery process for patients undergoing pulmonary resections and are recommended as the standard of care over traditional analog water seal systems. The digital device features allow for objective assessment of measurement data, including air leaks and drainage fluid, in addition to continuous data trending which providers can use to determine when it is safe to remove a chest EXECUTIVE SUMMARY 3 tube after surgery (Geraci et al., 2022). The digital device has proven to reduce patient’s hospital length of stay, enhance clinical decision-making, and allow for easier patient mobilization (Wang et al., 2019). The project site, a southeastern medical institution, purchased ten reusable digital systems to trial in a pilot study of patients who had elective pulmonary resections and recovered in the Cardiovascular Intermediate Unit (CVIU). However, the institution lacked a standardized process for implementing the new devices. The purpose of this quality improvement project was to develop an operational process to initiate the use of the digital systems at this institution. The aims of this project sought to determine if the digital system would reduce elective pulmonary resection patients’ length of stay, compared to the traditional analog system, and improve the efficiency of nursing care. The project aligns with the pillars of the National Institute of Health’s quadruple aim which seeks to enhance patient safety, standardize clinical workflows, and improve healthcare provider satisfaction (Holmgren et al., 2023; Ingelheim, 2023). Methodology This project spanned four semesters from January 2024 through April 2025 and consisted of concept formation, literature review, project design, implementation, data analysis, and dissemination of findings. The project site was the Cardiovascular Intermediate Unit of a large southeastern medical institution. Plan Do Study Act (PDSA) cycles were utilized to refine nurse and device education in addition to operational processes during monitoring. The project implementation process took place over 12 weeks and was divided into two phases: education and monitoring. A nurse pre-implementation survey was disseminated via a quick response (QR) code before education began to assess nurse confidence and opinion using traditional analog systems. During the education phase, digital device representatives conducted EXECUTIVE SUMMARY 4 10-minute in-service training sessions for three days during day and night shift huddles, demonstrating device functionality and operational instructions for nursing staff. Super users, including charge nurses and unit managers, received additional troubleshooting and device management training. The lead thoracic surgery nurse practitioner held informal teaching sessions regarding the expectations of electronic health record (EHR) documentation. During the monitoring phase, the digital device was used on eighteen patients. Nurse EHR audit checks were completed weekly for all patients using the digital device. The EHR audit check tracked patient admission dates, discharge dates, and nurse documentation. After monitoring, a nurse post-implementation survey was disseminated via a QR code to assess nurse confidence and opinion using digital systems. Quantitative data was extracted from nurse surveys and EHR audits. Frequencies were tabulated and analyzed for comparison. Results Of the 18 patients who used the digital device, 11 patients were discharged on postoperative day one or postoperative day two, two patients were discharged on postoperative day 10, and one patient was discharged on postoperative day 12. When compared to the data of patient cases utilizing the analog systems, in a similar time period, all 19 analog system patients were discharged on or before postoperative day five. These findings suggest the digital system did not have a profound difference in reducing the length of stay compared to analog systems. Regarding whether digital devices improved nursing care, 94% of nurses felt extracting the data from the digital device was easy or very easy and 100% of nurses felt ambulating the patient with the digital system was easy or very easy. Nurses liked the digital features of the device as it improved the efficiency of nurse workflow and was safer for patient ambulation. The EXECUTIVE SUMMARY 5 nurse EHR documentation compliance rate was 89% suggesting continual staff education is pertinent to ensure protocols and processes are followed. Strengths and Limitations The project’s strengths include developing processes and protocols that can be replicated to expand the digital device’s use within the unit and to others in the institution. Nurse feedback and opinions regarding the digital device’s functionality were positive, as they felt the device offered multiple benefits to both nurses and patients. Limitations included a small sample size due to the short duration of the project’s implementation and data collection, damage to one device during the trial period resulting in its removal from circulation, and the discovery that the digital device is not compatible with MRI Three patients had complications post-surgery while using the digital device, which inevitably prolonged their stay, noted as outliers in the data. It is uncertain why complications arose, but device error cannot be ruled out as a causative factor and may or may not have resulted in their prolonged stay. Implications and Conclusion The implementation of the digital device in the CVIU was well received by the nursing staff overall. Nurses spent less time analyzing air leak and drainage output measurements because the device readily computed and displayed the data for fast extraction. Nurses also reported the digital system was more accurate at measuring data and took the pressure off their nursing judgment because the device eliminates intra-observer variability. The device’s built-in suction system mitigated extra tubes and cords, resulting in safe patient ambulation. These implications align with the existing literature emphasizing that digital chest tube drainage systems enhance clinical decision-making and improve patient safety (Jacobsen et al., 2019). EXECUTIVE SUMMARY 6 However, the lack of a reduction in the patient’s length of stay indicates the need to further explore chest tube dwell time utilizing the digital device. Future research should focus on a longer duration of data collection to increase sample size, improve nurse EHR education to ensure all data is properly documented, and evaluate a cost-savings analysis to determine the device’s overall monetary effectiveness. Another aspect that should be considered is the patient’s opinions and experiences regarding the device. Finally, if this device is to be expanded to other units in the hospital, a designed nurse educator or device super user should serve as the clinical device expert. In summary, this quality improvement project successfully initiated the digital chest drainage system in the CVIU. The institution can use these findings as foundational guidance to determine the device’s value. EXECUTIVE SUMMARY 7 References Geraci, T. C., Sorensen, A., James, L., Chen, S., El Zaeedi, M., Cerfolio, R. J., & Zervos, M. (2022). Use of a novel digital drainage system after pulmonary resection. Journal of Thoracic Disease, 14(9), 3145–3153. https://doi.org/10.21037/jtd-22-574 Holmgren, A. J., McBride, S., Gale, B., & Mossburg, S. (2023, March 29). Technology as a tool for improving patient safety. Patient Safety Network. https://psnet.ahrq.gov/perspective/technology-tool-improving-patient-safety Ingelheim, B. (2023, October 26). Overview quadruple aim. Strategies for Quality Care. https://www.strategiesforqualitycare.com/quadruple-aim Jacobsen, K., Talbert, S., & Boyer, J. H. (2019). The benefits of digital drainage system versus traditional drainage system after robotic-assisted pulmonary lobectomy. Journal of Thoracic Disease, 11(12), 5328–5335. https://doi.org/10.21037/jtd.2019.11.69 Stoumpos, A. I., Kitsios, F., & Talias, M. A. (2023). Digital Transformation in Healthcare: Technology Acceptance and its applications. International Journal of Environmental Research and Public Health, 20(4), 3407. https://doi.org/10.3390/ijerph20043407 Wang, H., Hu, W., Ma, L., & Zhang, Y. (2019). Digital chest drainage system versus traditional chest drainage system after pulmonary resection: A systematic review and meta-analysis. EXECUTIVE SUMMARY 8 Journal of Cardiothoracic Surgery, 14(1). https://doi.org/10.1186/s13019-019-0842-x