Piloting electronic medical record–based early detection of inpatient deterioration in community hospitals
- 2 November 2016
- journal article
- research article
- Published by Wiley in Journal of Hospital Medicine
- Vol. 11 (S1), S18-S24
- https://doi.org/10.1002/jhm.2652
Abstract
Patients who deteriorate in the hospital outside the intensive care unit (ICU) have higher mortality and morbidity than those admitted directly to the ICU. As more hospitals deploy comprehensive inpatient electronic medical records (EMRs), attempts to support rapid response teams with automated early detection systems are becoming more frequent. We aimed to describe some of the technical and operational challenges involved in the deployment of an early detection system. This 2‐hospital pilot, set within an integrated healthcare delivery system with 21 hospitals, had 2 objectives. First, it aimed to demonstrate that severity scores and probability estimates could be provided to hospitalists in real time. Second, it aimed to surface issues that would need to be addressed so that deployment of the early warning system could occur in all remaining hospitals. To achieve these objectives, we first established a rationale for the development of an early detection system through the analysis of risk‐adjusted outcomes. We then demonstrated that EMR data could be employed to predict deteriorations. After addressing specific organizational mandates (eg, defining the clinical response to a probability estimate), we instantiated a set of equations into a Java application that transmits scores and probability estimates so that they are visible in a commercially available EMR every 6 hours. The pilot has been successful and deployment to the remaining hospitals has begun. Journal of Hospital Medicine 2016;11:S18–S24. © 2016 Society of Hospital MedicineKeywords
Funding Information
- Gordon and Betty Moore Foundation
This publication has 24 references indexed in Scilit:
- Risk factors for unplanned transfer to intensive care within 24 hours of admission from the emergency department in an integrated healthcare systemJournal of Hospital Medicine, 2012
- Early detection of impending physiologic deterioration among patients who are not in intensive care: Development of predictive models using data from an automated electronic medical recordJournal of Hospital Medicine, 2012
- Adverse outcomes associated with delayed intensive care unit transfers in an integrated healthcare systemJournal of Hospital Medicine, 2011
- Intra‐hospital transfers to a higher level of care: Contribution to total hospital and intensive care unit (ICU) mortality and length of stay (LOS)Journal of Hospital Medicine, 2010
- Unplanned transfers to a medical intensive care unit: Causes and relationship to preventable errors in careJournal of Hospital Medicine, 2010
- Matching Methods for Causal Inference: A Review and a Look ForwardStatistical Science, 2010
- Risk-Adjusting Hospital Inpatient Mortality Using Automated Inpatient, Outpatient, and Laboratory DatabasesMedical Care, 2008
- Rapid response systems: A systematic review*Critical Care Medicine, 2007
- Design and analysis of stepped wedge cluster randomized trialsContemporary Clinical Trials, 2007
- The Medical Emergency Team: a new strategy to identify and intervene in high-risk patientsClinical Intensive Care, 1995