Real-Time Automated Sampling of Electronic Medical Records Predicts Hospital Mortality

Abstract Background Rapid response systems (RRSs) are essential components of patient safety systems; however, limited evidence exists regarding their effectiveness and optimal structures. We aimed to assess the activation patterns and outcomes of RRS implementation with/without a real-time automatic alerting system (AAS) based on electronic medical records (EMRs). Methods We retrospectively analyzed clinical data of patients for whom the RRS was activated in the surgical wards of a tertiary university hospital. We compared the code rate, in-hospital mortality, unplanned intensive care unit (ICU) admission, and other clinical outcomes before and after applying RRS and AAS as follows: pre-RRS (January 2013–July 2015), RRS without AAS (August 2015–November 2016), and RRS with AAS (December 2016–December 2017). Results In-hospital mortality per 1000 admissions decreased from 15.1 to 12.9 after RRS implementation (p < 0.001). RRS activation per 1000 admissions increased from 14.4 to 26.3 after AAS implementation. The severity of patients’ condition calculated using the modified early warning score increased from 2.5 (± 2.1) in the RRS without AAS to 3.6 (± 2.1) (p < 0.001) in the RRS with AAS. The total and preventable code rates and in-hospital mortality rates were comparable between the RRS implementation periods without/with AAS. ICU duration and mortality results improved in patients with RRS activation and unplanned ICU admission. The data of RRS non-activated group remained unaltered during the study. Conclusions Real-time AAS based on EMRs might help identify unstable patients. Early detection and intervention with RRS may improve patient outcomes.

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Confronting real time ethical, legal, and social issues in the Electronic Medical Records and Genomics (eMERGE) Consortium

Genetics in Medicine ◽

10.1097/gim.0b013e3181efdbd0 ◽

2010 ◽

Vol 12 (10) ◽

pp. 616-620 ◽

Cited By ~ 41

Author(s):

Ellen Wright Clayton ◽

Maureen Smith ◽

Stephanie M Fullerton ◽

Wylie Burke ◽

Catherine A McCarty ◽

...

Keyword(s):

Real Time ◽

Electronic Medical Records ◽

Medical Records ◽

Social Issues

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Rapid real time surveillance and monitoring of pandemic influenza associated pneumonia & risk factors using primary care electronic medical records (EMR)

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2010.02.2209 ◽

2010 ◽

Vol 14 ◽

pp. e324

Author(s):

T. Wong ◽

J.G. Mercer ◽

S. Mukhi ◽

S. Totten ◽

K. El Eman ◽

...

Keyword(s):

Risk Factors ◽

Primary Care ◽

Real Time ◽

Electronic Medical Records ◽

Pandemic Influenza ◽

Medical Records

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Access to Shared Electronic Medical Records to Improve Adherence and Management of Discharge Medications

The Senior Care Pharmacist ◽

10.4140/tcp.n.2021.49 ◽

2021 ◽

Vol 36 (1) ◽

pp. 49-55

Author(s):

Vinita Mistry ◽

Meghan McKee

Keyword(s):

Real Time ◽

Electronic Medical Records ◽

Medical Records ◽

Medical Center ◽

Transitions Of Care ◽

Home Based Primary Care ◽

Pharmacist Interventions ◽

Home Based ◽

Acute Care Facilities ◽

The Impact

Objective: The aim of the study is to assess the impact of shared electronic medical records (EMR) on the ability of pharmacists to provide medication reconciliation and clinical interventions in home-based primary care (HBPC) veterans hospitalized outside of the Veterans Affairs Medical Center (VAMC). Design: This was a single-centered, retrospective quality improvement study. An assessment of medical records was conducted to analyze changes in ability to conduct medication reconciliations and interventions in HBPC Veterans hospitalized prior- to and postaccess to shared EMR systems with local non-VA acute care facilities. Setting: VAMC. Patients: HBPC veterans hospitalized outside of the VAMC. Ninety-eight veteran cases were assessed and 59 enrolled into the retrospective study. Interventions: Impact of access to real-time shared EMR systems outside of the VAMC facility on the ability to provide appropriate and timely medication reconciliations and interventions. Main Outcome Measures: Data collection occurred between January and March 2019 and January and March 2020. Number of medication reconciliations conducted, pharmacist interventions made, and time taken to complete transitions of care (TOC) evaluations following hospital discharge were assessed. Results: The number of medication reconciliations completed preaccess to shared EMR was 41.9% versus 85.7% in the postaccess group. The percent hospitalizations with pharmacist interventions was 35.5% preaccess and 60.7% postaccess. The mean number of days to complete a TOC note following discharge from the hospital was 15.2 (±20.2) days preaccess versus 5.3 (±5.7) days postaccess. Conclusions: Shared EMR systems provide pharmacists reliable and real-time access to patient chart data, laboratory results, and discharge summaries, allowing for timelier medication reconciliations and clinical pharmacist interventions.

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PNS1 THE DEVELOPMENT OF A FRAMEWORK TO EVALUATE OUTCOMES WITHIN REAL-TIME DATA FROM ELECTRONIC MEDICAL RECORDS (EMR).

Value in Health ◽

10.1016/j.jval.2020.04.1015 ◽

2020 ◽

Vol 23 ◽

pp. S284

Author(s):

B. Zanotto ◽

A.P. Etges ◽

A.C. Souza ◽

A. Dal Bosco ◽

E.G. Cortes ◽

...

Keyword(s):

Real Time ◽

Electronic Medical Records ◽

Medical Records ◽

Time Data ◽

Real Time Data

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Using Electronic Medical Records of Nursing Care to Characterize Constipation in Patients with Intracerebral Hemorrhage

Cerebrovascular Diseases ◽

10.1159/000515706 ◽

2021 ◽

pp. 1-8

Author(s):

Wei Chen ◽

Jieyi Zhao ◽

Xiangkui Li ◽

Xiaoyu Wang ◽

Jing Chen ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Intracerebral Hemorrhage ◽

Hospital Mortality ◽

Electronic Medical Records ◽

Nursing Care ◽

Medical Records ◽

Care Center ◽

Tertiary Care

Introduction: Constipation is one of the common poststroke complications that directly affect the patients’ quality of life in patients with intracerebral hemorrhage (ICH), which has not been paid enough attention. Objective: This study investigates constipation’s clinical characteristics and its risk factors in ICH patients driven by the electronic medical records of nursing care. Methods: This retrospective chart review investigated patients with acute spontaneous ICH admitted at a tertiary care center from October 2010 to December 2018. Poststroke constipation was defined as a first stool passage occurring after 3 days postadmission and the use of enemas or laxatives after ICH. The associations between constipation present and potential factors were evaluated. Results: Of 1,748 patients, 408 (70.3% men, mean age 58 ± 14 years) patients with poststroke constipation were identified. After adjusting for potential confounding variables, the risk factors independently associated with poststroke constipation are admission Glasgow Coma Scale score (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.44–0.88; p = 0.007), use of mechanical ventilation (OR 3.74, 95% CI 2.37–5.89, p < 0.001), enteral nutrition (OR 2.82, 95% CI 1.85–4.30, p < 0.001), hematoma evacuation (OR 2.10, 95% CI 1.40–3.16; p < 0.001), opioid analgesics (OR 1.86, 95% CI 1.32–2.62; p < 0.001), sedation (OR 1.83, 95% CI 1.20–2.77; p = 0.005), and vasopressors (OR 1.81, 95% CI 1.26–2.61; p = 0.001) in order. Similar associations were observed in the prespecified length of the stay subgroup. Patients with constipation were associated with a longer hospital stay length (2.24 days, 95% CI 1.43–3.05, p < 0.001) but not with in-hospital mortality (OR 1.05, 95% CI 0.58–1.90, p = 0.871). Conclusions: Our findings suggested that risk factors influence the absence of constipation after ICH with the synergy of different weights. The occurrence of constipation likely affects a longer length of stay, but not in-hospital mortality. Future prospective investigations are warranted to validate our findings and identify the optimal management of constipation that may improve the quality of life in patients with ICH.

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Severe obesity is associated with higher in-hospital mortality in a cohort of patients with COVID-19 in the Bronx, New York

10.1101/2020.05.05.20091983 ◽

2020 ◽

Cited By ~ 1

Author(s):

Leonidas Palaiodimos ◽

Damianos G. Kokkinidis ◽

Weijia Li ◽

Dimitrios Karamanis ◽

Jennifer Ognibene ◽

...

Keyword(s):

New York ◽

Hospital Mortality ◽

Electronic Medical Records ◽

Medical Records ◽

Severe Obesity ◽

Medical Center ◽

Underrepresented Minorities ◽

Oxygen Requirement ◽

Prevalence Of Obesity ◽

Male Sex

ABSTRACTBackground & AimsNew York is the current epicenter of Coronavirus disease 2019 (COVID-19) pandemic. The underrepresented minorities, where the prevalence of obesity is higher, appear to be affected disproportionally. Our objectives were to assess the characteristics and early outcomes of patients hospitalized with COVID-19 in the Bronx and investigate whether obesity is associated with worse outcomes.MethodsThis retrospective study included the first 200 patients admitted to a tertiary medical center with COVID-19. The electronic medical records were reviewed at least three weeks after admission. The primary endpoint was in-hospital mortality.Results200 patients were included (female sex: 102, African American: 102). The median BMI was 30 kg/m2. The median age was 64 years. Hypertension (76%), hyperlipemia (46.2%), and diabetes (39.5%) were the three most common comorbidities. Fever (86%), cough (76.5%), and dyspnea (68%) were the three most common symptoms. 24% died during hospitalization (BMI <25 kg/m2: 31.6%, BMI 25-34 kg/m2: 17.2%, BMI≥35 kg/m2: 34.8%, p= 0.03). The multivariate analysis for mortality, demonstrates that BMI≥35 kg/m2 (OR: 3.78; 95% CI: 1.45 - 9.83; p=0.006), male sex (OR: 2.74; 95% CI: 1.25 - 5.98; p=0.011) and increasing age (OR: 1.73; 95% CI: 1.13 - 2.63; p=0.011) were independently associated with higher in hospital mortality. Similar results were obtained for the outcomes of increasing oxygen requirement and intubation.ConclusionsIn this cohort of hospitalized patients with COVID-19 in a minority-predominant population, severe obesity, increasing age, and male sex were associated with higher in-hospital mortality and in general worse in-hospital outcomes.

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Access to Shared Electronic Medical Records to Improve Adherence and Management of Discharge Medications

The Senior Care Pharmacist ◽

10.4140/tcp.n.2021.49. ◽

2021 ◽

Vol 36 (1) ◽

pp. 49-55

Author(s):

Vinita Mistry ◽

Meghan McKee

Keyword(s):

Real Time ◽

Electronic Medical Records ◽

Medical Records ◽

Medical Center ◽

Transitions Of Care ◽

Home Based Primary Care ◽

Pharmacist Interventions ◽

Home Based ◽

Acute Care Facilities ◽

The Impact

OBJECTIVE: The aim of the study is to assess the impact of shared electronic medical records (EMR) on the ability of pharmacists to provide medication reconciliation and clinical interventions in home-based primary care (HBPC) veterans hospitalized outside of the Veterans Affairs Medical Center (VAMC).DESIGN: This was a single-centered, retrospective quality improvement study. An assessment of medical records was conducted to analyze changes in ability to conduct medication reconciliations and interventions in HBPC Veterans hospitalized prior- to and postaccess to shared EMR systems with local non-VA acute care facilities.SETTING: VAMC.PATIENTS: HBPC veterans hospitalized outside of the VAMC. Ninety-eight veteran cases were assessed and 59 enrolled into the retrospective study.INTERVENTIONS: Impact of access to real-time shared EMR systems outside of the VAMC facility on the ability to provide appropriate and timely medication reconciliations and interventions.MAIN OUTCOME MEASURES: Data collection occurred between January and March 2019 and January and March 2020. Number of medication reconciliations conducted, pharmacist interventions made, and time taken to complete transitions of care (TOC) evaluations following hospital discharge were assessed.RESULTS: The number of medication reconciliations completed preaccess to shared EMR was 41.9% versus 85.7% in the postaccess group. The percent hospitalizations with pharmacist interventions was 35.5% preaccess and 60.7% postaccess. The mean number of days to complete a TOC note following discharge from the hospital was 15.2 (±20.2) days preaccess versus 5.3 (±5.7) days postaccess.CONCLUSIONS: Shared EMR systems provide pharmacists reliable and real-time access to patient chart data, laboratory results, and discharge summaries, allowing for timelier medication reconciliations and clinical pharmacist interventions.

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Which Sections of Electronic Medical Records Are Most Relevant for Real-Time Surveillance of Influenza- like Illness?

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v8i1.6450 ◽

2016 ◽

Vol 8 (1) ◽

Author(s):

Dino P. Rumoro ◽

Shital C. Shah ◽

Marilyn M. Hallock ◽

Gillian S. Gibbs ◽

Gordon M. Trenholme ◽

...

Keyword(s):

Real Time ◽

Electronic Medical Records ◽

Medical Records ◽

Influenza Like Illness

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Acute kidney injury in patients with Covid-19 in a Brazilian ICU: incidence, predictors and in-hospital mortality

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2020-0144 ◽

2021 ◽

Author(s):

Rafael Lessa da Costa ◽

Taíza Corrêa Sória ◽

Eliene Ferreira Salles ◽

Ana Venâncio Gerecht ◽

Maurício Faria Corvisier ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Electronic Medical Records ◽

Predictive Factors ◽

Medical Records ◽

Distress Syndrome ◽

Estimated Glomerular Filtration Rate ◽

Kidney Injury ◽

Average Survival ◽

High Incidence

Abstract Introduction: There is little data in the literature on acute kidney injury (AKI) in Covid-19 cases, although relevant in clinical practice in the ICU, especially in Brazil. Our goal was to identify the incidence of AKI, predictive factors and impact on hospital mortality. Method: Retrospective cohort of patients with Covid-19 admitted to the ICU. AKI was defined according to KDIGO criteria. Data was collected from electronic medical records between March 17 and April 26. Results: Of the 102 patients, 55.9% progressed with AKI, and the majority (66.7%) was classified as stage 3. Multivariate logistic regression showed age (RC 1.101; 95% CI 1.026 - 1.181; p = 0.0070), estimated glomerular filtration rate - eGFR (RC 1.127; 95% CI 1.022 - 1.243; p = 0.0170) and hypertension (RC 3.212; 95% CI 1.065 - 9.690; p = 0.0380) as independent predictors of AKI. Twenty-three patients died. In the group without kidney injury, there were 8.9% deaths, while in the group with AKI, 33.3% of patients died (RR 5.125; 95% CI 1.598 - 16.431; p = 0.0060). The average survival, in days, was higher in the group without AKI. Cox multivariate analysis showed age (RR 1.054; 95% CI 1.014 - 1.095; p = 0.0080) and severe acute respiratory distress syndrome (RR 8.953; 95% CI 1.128 - 71.048; p = 0.0380) as predictors of hospital mortality. Conclusion: We found a high incidence of AKI; and as predictive factors for its occurrence: age, eGFR and hypertension. AKI was associated with higher hospital mortality.

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