Team Zorg Enablers
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Implementations | Control & Monitoring


Being submitted to the Intensive Care (IC) is a moving experience. A patient can end up with long-lasting physical and psychological complaints (the Post Intensive Care Syndrome (PICS)). Having the patient, their family and nurses keep a diary is currently the only clinically validated intervention to mitigate PICS. “A paper diary was already being used at the IC department of the Catharina Hospital. Arts and crafts don’t fit into these times and a paper diary is difficult to use both at home and with the patient’,” states Marc Buise. In 2018, in order to provide patients and family members with some guidance during the period after the IC, Buise, along with Games for Health (GFH), initiated the development of a digital version of the ‘Post-IC diary of tomorrow’. The diary can easily be created online by the patient or a family member. When the diary is created, next of kin and nurses can also contribute to the virtual diary with text, photographs, film- and sound fragments. “The diary was already used in 500 B.C. How cool is it to employ this mechanism again, now, in this modern version,” says Jurriaan van Rijswijk.

With the arrival of COVID-19, the use of the digital Post-IC diary was accellerated. In April 2020, the start of a pilot with the digital diary in the Catharina Hospital was accellerated, with support of Zorgverzekeraars Nederland and the Rabobank. To this end, an iterative process was followed in co-creation with the IC nurses. Reasoning was continuously approached from possibilities, instead of impossibilities. The choice was made to start small and scale up gradually, so the added value of the digital diary became increasingly visible. And with the collaboration between the Catharina Hospital and GFH, professional knowledge was combined with technical expertise.

Van Rijswijk: “The implementation process consisted of roughly three parts: technical, legal, and communicative implementation. The technical implementation, for example, also involved the user-friendliness of the digital diary.” In the meantime, the diary functions as a web application on a computer next to the IC bed where nurses can easily log into the diary from the patient file. A tablet is also available to each IC unit, with which pictures can be made and uploaded to the diary. “For the legal implementation, the focus was on everything ‘from contact to contract’. Think of Privacy Impact Assessments, user agreements, and consent forms. Many joint conversations were held with privacy officers (CISOs) of hospitals to reach a consensus on this, since this new innovation also created many new privacy issues,” Buise says. Finally, much attention was paid to the transfer of information and creating ambassadors. Van Rijswijk: “It always starts with a group of enthusiasts. After that, you have to ensure that group grows and the digital diary becomes a part of the standard work process.”

The success of the Post-IC diary demonstrates how it responds to a specific demand. By now, the digital Post-IC diary has been implemented at over 10 Dutch hospitals, with support from the Rabobank, Zorgverzekeraars Nederland, and insurance provider CZ. Besides that, multiple parties support the innovation, and a multicenter validation study by ZonMw into the effectiveness of the digital application is up and running. Van Rijswijk: “Our implementation process was recorded in a blueprint for scaling up, which enables us to implement the digital diary in a new hospital in 50-70 hours on average. We are supported in this by implementation partners in specific fields of expertise. This is how we are able to connect 10 extra ICs this year. And hopefully another 20-30 ICs next year.” Germany and the US are also examining possibilities for scaling up already. The innovation was therefore selected by startup platform Techleap as one of the seminal innovations in their COVID-19 programme. Buise: “Our goal is that all IC patients in the Netherlands and beyond can use the Post-IC diary of tomorrow.”



Marc Buise is anaesthetist-intensivist at the IC of the Catharina Hospital, and the initiator of the Post-IC diary of tomorrow. The Catharina Hospital was the first hospital to implement the Post-IC diary. Jurriaan van Rijswijk is the founder of Games for Health, an organisation for digital innovation in patient-oriented healthcare.