scholarly journals Evaluating a digital sepsis alert in a multi-site hospital: a natural experiment

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
K Honeyford ◽  
G S Cooke ◽  
A Kinderlerer ◽  
E Williamson ◽  
M Gilchrist ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Patient Outcomes ◽  
Natural Experiment ◽  
Digital Health ◽  
Unintended Consequences ◽  
Health Records ◽  
Process Measures ◽  
Lower Odds ◽  
Causal Pathway ◽  
The Impact

Abstract Background This study investigated the impact of a digital sepsis alert on patient outcomes in a busy London multi-site hospital. Sepsis is a serious illness and common cause of death, but rapid diagnosis and treatment improve patient outcomes. Digital health records allow algorithms to be embedded which ‘alert’ clinicians to patients who are at risk of developing sepsis. Despite the current promotion of ‘digital health’, evidence of the impact of algorithm driven alerts on patient outcomes is limited. Methods A retrospective natural experiment utilising the phased introduction of a digital sepsis alert into a large, multi-site hospital in England. Silent alerts (not visible to clinicians) acted as controls. Outcome measures were in-hospital all-cause mortality within 30 days of the alert, extended hospital stay (≥7 days) and timely antibiotics (≤60 minutes of the alert). Inversely weighted multivariable logistic regression was used to determine associations between alert and patient outcomes. Results In a sample of 21,183 inpatients, the mortality rate was 5.9%. The active, visible alert was associated with lower odds of death (Odds Ratio (OR):0.76; 95%CI:(0.70, 0.84)). In 9988 emergency department attendances ending in admission, 40.6% had an extended hospital stay and 41.5% received timely antibiotics. The active alert was associated with lower odds of extended hospital stay (OR:0.93; 95%CI:(0.88, 0.99)) and increased odds of receiving timely antibiotics (OR:1.71; 95%CI:(1.57, 1.87)). Conclusions This study demonstrates that a move to digital health, through an automated sepsis alert, embedded in digital health records, was associated with improved health outcomes. Further work is needed to identify the causal pathway, which is likely to include more rapid treatment with antibiotics, and possible unintended consequences. These findings support the ongoing roll out of digital alerting and provide a model for robustly evaluating their impact. Key messages The introduction of an automated sepsis alert associated with the use of improvement methodology was associated with improved process measures and patient outcomes. Introduction of digital health interventions can, and should, be robustly evaluated with appropriate statistical approaches.

scholarly journals Evaluating a digital sepsis alert in a London multi-site hospital network: a natural experiment using electronic health record data

2019 ◽  
Author(s):  
Kate Honeyford ◽  
Graham S Cooke ◽  
Anne Kinderlerer ◽  
Elizabeth Williamson ◽  
Mark Gilchrist ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Patient Outcomes ◽  
Natural Experiment ◽  
Research Centre ◽  
Current Evidence ◽  
Prolonged Hospital Stay ◽  
Lower Odds ◽  
Improved Outcomes ◽  
Prolonged Hospital ◽  
The Impact

ABSTRACTObjectiveTo determine the impact of a digital sepsis alert on patient outcomes in a UK multi-site hospital network.MethodsA natural experiment utlising the phased introduction of a digital sepsis alert into a multi-site hospital network. Sepsis alerts were either visible to clinicans (the ‘intervention’ group) or running silently and not visible (the control group). Inverse probability of treatment weighted multivariable logistic regression was used to estimate the effect of the intervention on patient outcomes.Outcomes: In-hospital 30-day mortality (all inpatients), prolonged hospital stay (≥7 days) and timely antibiotics (≤60 minutes of the alert) for patients who alerted in the Emergency Department.ResultsThe introduction of the alert was associated with lower odds of death (OR:0.76; 95%CI:(0.70, 0.84) n=21,183); lower odds of prolonged hospital stay ≥7 days (OR:0.93; 95%CI:(0.88, 0.99) n=9988); and in patients who required antibiotics, an increased odds of receiving timely antibiotics (OR:1.71; 95%CI:(1.57,1.87) n=4622).DiscussionCurrent evidence that digital sepsis alerts are effective is mixed. In this large UK study a digital sepsis alert has been shown to be associated with improved outcomes, including timely antibiotics, which may suggest a causal pathway. It is not known whether the presence of alerting is responsible for improved outcomes, or whether the alert acted as a useful driver for quality improvement initiatives.ConclusionsThese findings strongly suggest that the the introduction of a network-wide digital sepsis alert is associated with improvements in patient outcomes, demonstrating that digital based interventions can be successfully introduced and readily evaluated.FundingImperial NIHR Biomedical Research Centre: NIHR-BRC-P68711.

scholarly journals Evaluating a digital sepsis alert in a London multisite hospital network: a natural experiment using electronic health record data

2019 ◽  
Vol 27 (2) ◽  
pp. 274-283 ◽  
Author(s):  
Kate Honeyford ◽  
Graham S Cooke ◽  
Anne Kinderlerer ◽  
Elizabeth Williamson ◽  
Mark Gilchrist ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Patient Outcomes ◽  
Natural Experiment ◽  
Current Evidence ◽  
Prolonged Hospital Stay ◽  
Electronic Health Record Data ◽  
Lower Odds ◽  
Improved Outcomes ◽  
Prolonged Hospital ◽  
The Impact

Abstract Objective The study sought to determine the impact of a digital sepsis alert on patient outcomes in a UK multisite hospital network. Materials and Methods A natural experiment utilizing the phased introduction (without randomization) of a digital sepsis alert into a multisite hospital network. Sepsis alerts were either visible to clinicians (patients in the intervention group) or running silently and not visible (the control group). Inverse probability of treatment-weighted multivariable logistic regression was used to estimate the effect of the intervention on individual patient outcomes. Outcomes In-hospital 30-day mortality (all inpatients), prolonged hospital stay (≥7 days) and timely antibiotics (≤60 minutes of the alert) for patients who alerted in the emergency department. Results The introduction of the alert was associated with lower odds of death (odds ratio, 0.76; 95% confidence interval [CI], 0.70-0.84; n = 21 183), lower odds of prolonged hospital stay ≥7 days (OR, 0.93; 95% CI, 0.88-0.99; n = 9988), and in patients who required antibiotics, an increased odds of receiving timely antibiotics (OR, 1.71; 95% CI, 1.57-1.87; n = 4622). Discussion Current evidence that digital sepsis alerts are effective is mixed. In this large UK study, a digital sepsis alert has been shown to be associated with improved outcomes, including timely antibiotics. It is not known whether the presence of alerting is responsible for improved outcomes or whether the alert acted as a useful driver for quality improvement initiatives. Conclusions These findings strongly suggest that the introduction of a network-wide digital sepsis alert is associated with improvements in patient outcomes, demonstrating that digital based interventions can be successfully introduced and readily evaluated.

scholarly journals Digital transformation of the emergency department-inpatient interface (EDii): integration for future innovation

2020 ◽  
Vol 44 (5) ◽  
pp. 666
Author(s):  
Andrew Staib ◽  
Clair Sullivan ◽  
Cara Joyce Cabilan ◽  
Rohan Cattell ◽  
Rob Eley
Keyword(s):  
Electronic Medical Records ◽  
Patient Outcomes ◽  
Medical Records ◽  
Emergency Admission ◽  
Tertiary Hospital ◽  
Digital Transformation ◽  
Relative Reduction ◽  
Process Measures ◽  
The Impact

As the focus of clinicians and government shifts from speciality-based care to system-based key performance indicators such as the National Emergency Access Target (NEAT) or the 4-h rule, integration between emergency department (ED) and inpatient clinical workflows and information systems is becoming increasingly necessary. Such system measures drive the implementation of integrated electronic medical records (ieMR) to digitally integrate these workflows. The objective of this case study was to describe the impact of digital transformation of the ED–in-patient interface (EDii) of a large tertiary hospital on process measures and clinical outcomes for patients requiring emergency admission to hospital. Data were collected from routine clinical and administrative information systems to measure process and clinical outcome measures, including ED length of stay, compliance with the 4-h rule and in-patient mortality between 28 November 2014 and 28 February 2017. The 4-h rule compliance for all patients, as well as for the EDii group (admitted to hospital excluding short stay ward), declined after digitisation. There were 55 fewer deaths in the postintervention group (15% relative reduction; P = 0.02) and a 10% relative reduction in adjusted mortality as measured by the Hospital Standardised Mortality Ratio for emergency patients (eHSMR), which did not reach statistical significance. Digital deceleration in ED performance did occur with an ieMR rollout, but worsening of key patient outcomes was not observed. What is known about this topic? Much has been written about the introduction of electronic medical records (EMRs) in emergency departments. This work sits alongside a substantial body of evidence outlining the relationship between process measures of ED performance and important patient outcomes. However, much less is known about the impact of digital transformation on the complex adaptive system that is the EDii and the impact of digitisation on the vulnerable group of patients who require emergency admission to hospital. What does this paper add? The objective of this case study was to describe the effect of a rapid rollout of an integrated EMR. This EMR simultaneously transformed care delivery both in the ED and the inpatient space and impacted on the politically and clinically sensitive performance and outcome measures of the EDii in a large tertiary hospital. The present study is the first that specifically examined the effect of digitisation at the EDii. What are the implications for practitioners? The understanding that digital deceleration will occur, but that with good patient outcome monitoring worsening of key patient outcomes is not likely to occur, now holds a key place in digital transformation planning. The measures of the EDii examined in this case study provide a foundation for this montoring.

Cognitive screening in the acute hospital: Preliminary findings from a cognitive screening program in a university-affiliated, tertiary-referral hospital with 6-month interval outcomes

2016 ◽  
Vol 33 (S1) ◽  
pp. S190-S190
Author(s):  
C. Power ◽  
H. Bates ◽  
M. Healy ◽  
P. Gleeson ◽  
E. Greene
Keyword(s):  
Cognitive Impairment ◽  
Hospital Stay ◽  
Patient Outcomes ◽  
Length Of Hospital Stay ◽  
Cognitive Status ◽  
Acute Hospital ◽  
Normative Values ◽  
Discharge Destination ◽  
Cognitive Screening ◽  
The Impact

IntroductionCognitive impairment impacts on patient outcomes [1] but is under-recognised in acute hospitals [2]. Data on rates and degree of impairment among hospital inpatients remain sparse. This information is vital for strategic planning of health services as the European population ages.ObjectivesTo examine the rates and degree of cognitive impairment among patients aged 65 and older who were admitted to an acute general hospital and to assess its impact on patient outcomes.MethodsAll patients aged over 65 who were admitted over a 2-week period were invited to participate. Those who met the inclusion criteria were screened for delirium then underwent a cognitive screening battery. Normative values for age and level of education were obtained from the TILDA study [3]. Demographic and outcome data were obtained from medical records.ResultsOne hundred and forty-eight patients underwent cognitive screening. Thirty-nine over 148 (26%) met the DSM-IV criteria for dementia of whom only 16 (41%) had a previously-documented impairment. Thirty over 148 (20%) had evidence of cognitive impairment that did not meet criteria for dementia, only 3 (10%) of whom were previously documented. Seventy-three over 148 (49%) were normal. Six over 148 (4%) were not classifiable. The impact of cognitive status on length of hospital stay, number of readmissions in 6 months and discharge destination was investigated. Impact on length of stay was significant (P = 0.017) but significance was not achieved against number of readmissions or discharge destination.ConclusionsCognitive impairment is pervasive and under-recognised in the acute hospital and impacts on length of hospital stay. Longer interval analysis is necessary to investigate further implications.References 1–3 available upon request.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cardiac Surgeons after Vacation: Refreshed or Rusty?

2017 ◽  
Vol 65 (07) ◽  
pp. 524-527
Author(s):  
Jennifer Winick-Ng ◽  
Andrew McClure ◽  
Luc Dubois ◽  
Dave Nagpal ◽  
Blayne Welk
Keyword(s):  
Hospital Stay ◽  
Patient Outcomes ◽  
Odds Ratio ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Risk Of Death ◽  
Significant Difference ◽  
Cardiac Surgeons ◽  
The Impact ◽  
Vacation Period

Introduction Many surgeons describe feeling a bit out of practice when they return from a vacation. There have been no studies assessing the impact of surgeon vacation on patient outcomes. Methods We used administrative data from the province of Ontario to identify patients who underwent a coronary artery bypass grafting. Using a propensity score, we matched patients who underwent their procedure immediately after their surgeon returned from vacation of at least 7 days (n = 1,161) to patients who were not operated immediately before or after a vacation period (n = 2,138). Results There was no significant difference in patient mortality (odds ratio: 1.23, p = 0.52), length of operation (relative risk [RR]: 1.00 p = 0.58), or intensive care unit/hospital stay (RR: 0.97 p = 0.66/RR: 0.98 p = 0.54, respectively). Conclusion There was not a significant change in risk of death, operative length, or hospital stay after a surgeon vacation.

scholarly journals ERS International Congress 2020 virtual: highlights from the Allied Respiratory Professionals’ Assembly

2020 ◽  
pp. 00808-2020
Author(s):  
Elizabeth Smith ◽  
Max Thomas ◽  
Ebru Calik-Kutukcu ◽  
Irene Torres-Sánchez ◽  
Maria Granados-Santiago ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Digital Health ◽  
User Participation ◽  
Scientific Data ◽  
International Congress ◽  
Future Research ◽  
Valuable Insight ◽  
Early Assessment ◽  
European Respiratory Society ◽  
The Impact

This article provides an overview of outstanding sessions that were (co)organised by the Allied Respiratory Professionals (ARP) Assembly during the European Respiratory Society (ERS) International Congress 2020, which this year assumed a virtual format. The content of the sessions was mainly targeted at ARP, including respiratory function technologists and scientists, physiotherapists and nurses, and is summarised in this highlights article. Short take-home messages related to spirometry and exercise testing are provided, highlighting the importance of quality control. In addition, the need for quality improvement in sleep interventions is underlined as it may enhance patient outcomes and the working capacity of healthcare services. The promising role of digital health in chronic disease management is discussed, with emphasis on the value of end-user participation in the development of these technologies. Evidence on the effectiveness of airway clearance techniques in chronic respiratory conditions is provided along with the rationale for its use and challenges to be addressed in future research. Furthermore, the importance of assessing, preventing and reversing frailty in respiratory patients is discussed, with a clear focus on exercise-based interventions. Research on the impact of disease-specific fear and anxiety on patient outcomes draws attention to the need for early assessment and intervention. Finally, advances in nursing care related to treatment adherence, self-management and patients’ perspective in asthma and COPD are provided, highlighting the need for patient engagement and shared decision making. This highlights article provides readers with valuable insight into the latest scientific data and emerging areas affecting clinical practice of ARP.

E-health and its Impact on Indian Health Care: An Analysis

Paradigm ◽  
2019 ◽  
Vol 23 (2) ◽  
pp. 164-174
Author(s):  
Sukhpreet Kaur ◽  
Rajinder Kaur ◽  
Rashmi Aggarwal
Keyword(s):  
Health Services ◽  
Electronic Health Records ◽  
Patient Outcomes ◽  
Positive Impact ◽  
Developed Countries ◽  
Digital Data ◽  
Healthcare Sector ◽  
Health Records ◽  
Electronic Health ◽  
The Impact

Healthcare sector is progressing towards digitalization in every aspect such as e-consultations, health surveillance, health education and various other healthcare services. Developing countries like India lacks infrastructure to conduct studies to evaluate impact of these e-health services on patient outcomes. Various developed countries have electronic health records which makes evaluation of patient outcomes much easier. This paper aims to evaluate effect of e-health on patient outcomes in Indian healthcare scenario and future consequences of these e-health services. The integrative literature searches were conducted using various databases such as pubmed, google scholar and SCC web edition using keywords such as ‘e-health’, ‘telemedicine’, ‘mhealth’, ‘electronic health records’, ‘patient outcomes’ and ‘data protection laws’. From the papers retrieved only few papers studied impact of e health services in patient outcomes. Other papers assessed e-health on basis of accessibility, feasibility and medium of education in clinical practice. It was concluded that e-health services such as diagnostic services like teleopthalmology and tele ECG, distant consultation with specialist through telemedicine and adherence aids like automated voice reminder and pictorial messaging have positive impact on patient outcomes. Though e-health services can help us in various ways but it will also open the new Pandora box of problems in handling personal information. The information technology rules in India have certain grey areas in protection of digital data. In future, besides improving the data content of information system to analyse the impact of various services provided to the patients, we will have to relook the legal system to protect the data.

scholarly journals Digital health dashboards for improving health systems, healthcare delivery and patient outcomes: a systematic review protocol

2020 ◽  
Author(s):  
Charis Xuan Xie ◽  
Christopher Maher ◽  
Gustavo C Machado
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Care Delivery ◽  
Digital Health ◽  
Healthcare Delivery ◽  
Healthcare Setting ◽  
Systematic Review Protocol ◽  
Health Related ◽  
Review Protocol ◽  
The Impact

With the widespread uptake of EMRs across the world, massive health-related datasets have been generated and clinicians are often overwhelmed with the complexity in analysing those EMR data. To overcome this, digital health dashboards have been integrated into EMR systems to help clinicians make informed decisions and ensure reliable care delivery. Despite its increasing popularity in the healthcare setting, there is limited summary evidence investigating the effectiveness of digital health dashboards to improve healthcare delivery and patient outcomes. In this systematic review, we aim to look at the impact of digital health dashboards on the healthcare system, clinicians and patients. The objectives are to: i) investigate the effectiveness of digital health dashboards for improving healthcare delivery and patient outcomes in primary care and hospital settings, and ii) identify the types of dashboards and describe its features and visualisation techniques. This is the final version of the systematic review protocol, published as a preprint to create full transparency about the review process.

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