Impact of an emergency department electronic sepsis surveillance system on patient mortality and length of stay

Abstract Objective The purpose of this study was to determine whether an electronic health record–based sepsis alert system could improve quality of care and clinical outcomes for patients with sepsis. Materials and Methods We performed a patient-level interrupted time series study of emergency department patients with severe sepsis or septic shock between January 2013 and April 2015. The intervention, introduced in February 2014, was a system of interruptive sepsis alerts triggered by abnormal vital signs or laboratory results. Primary outcomes were length of stay (LOS) and in-hospital mortality; other outcomes included time to first lactate and blood cultures prior to antibiotics. We also assessed sensitivity, positive predictive value (PPV), and clinician response to the alerts. Results Mean LOS for patients with sepsis decreased from 10.1 to 8.6 days (P < .001) following alert introduction. In adjusted time series analysis, the intervention was associated with a decreased LOS of 16% (95% CI, 5%-25%; P = .007, with significance of α = 0.006) and no change thereafter (0%; 95% CI, −2%, 2%). The sepsis alert system had no effect on mortality or other clinical or process measures. The intervention had a sensitivity of 80.4% and a PPV of 14.6%. Discussion Alerting based on simple laboratory and vital sign criteria was insufficient to improve sepsis outcomes. Alert fatigue due to the low PPV is likely the primary contributor to these results. Conclusion A more sophisticated algorithm for sepsis identification is needed to improve outcomes.

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The effect of electronic medical record application on the length of stay in a Chinese general hospital: a department- and disease-focused interrupted time-series study

Journal of Medical Systems ◽

10.1007/s10916-014-0053-x ◽

2014 ◽

Vol 38 (5) ◽

Cited By ~ 6

Author(s):

Peng Yang ◽

Yi Cao ◽

Danhong Liu ◽

Yuxiang Bai ◽

Feng Pan ◽

...

Keyword(s):

Time Series ◽

Length Of Stay ◽

General Hospital ◽

Medical Record ◽

Electronic Medical Record ◽

Interrupted Time Series ◽

Time Series Study ◽

Series Study

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The association between the transfer of emergency department admitted patients to inpatient hallways and outcomes of oncology patients

Journal of Hospital Administration ◽

10.5430/jha.v4n2p1 ◽

2015 ◽

Vol 4 (2) ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Charles Lim ◽

Matthew C. Cheung ◽

Maureen E. Trudeau ◽

Kevin R. Imrie ◽

Ben De Mendonca ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Patient Flow ◽

Vital Signs ◽

Medication Administration ◽

Oncology Patients ◽

Flow Quality ◽

Ed Crowding ◽

The Impact

Objective: A protocol was implemented to ease Emergency Department (ED) crowding by moving suitable admitted patients into inpatient hallway beds (HALL) or off-service beds (OFF) when beds on an admitting service’s designated ward (ON) were not available. This study assessed the impact of hallway and off-service oncology admissions on ED patient flow, quality of care and patient satisfaction.Methods: Retrospective and prospective data were collected on patients admitted to the medical oncology service from Jan 1 to Dec 31, 2011. Data on clinician assessments and time performance measures were collected. Satisfaction surveys were prospectively administered to all patients. Results: Two hundred and ninty-seven patients (117 HALL, 90 OFF, 90 ON) were included in this study. There were no significant differences between groups for frequency of physician assessments, physical exam maneuvers at initial physician visit, time to complete vital signs or time to medication administration. The median (IQR) time spent admitted in the ED prior to departure from the ED was significantly longer for HALL patients (5.53 hrs [1.59-13.03 hrs]) compared to OFF patients (2.00 hrs [0.37-3.69 hrs]) and ON patients (2.18 hrs [0.15-5.57 hrs]) (p < .01). Similarly, the median (IQR) total ED length of stay was significantly longer for HALL patients (13.82 hrs [7.43-20.72 hrs]) compared to OFF patients (7.18 hrs [5.72-11.42 hrs]) and ON patients (9.34 hrs [5.43-14.06 hrs]) (p < .01). HALL patients gave significantly lower overall satisfaction scores with mean (SD) satisfaction scores for HALL, OFF and ON patients being 3.58 (1.20), 4.23 (0.58) and 4.29 (0.69) respectively (p < .01). Among HALL patients, 58% were not comfortable being transferred into the hallway and 4% discharged themselves against medical advice. Conclusions: The protocol for transferring ED admitted patients to inpatient hallway beds did not reduce ED length of stay for oncology patients. The timeliness and frequency of clinical assessments were not compromised; however, patient satisfaction was decreased.

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The impact of Australian healthcare reforms on emergency department time-based process outcomes: An interrupted time series study

PLoS ONE ◽

10.1371/journal.pone.0209043 ◽

2018 ◽

Vol 13 (12) ◽

pp. e0209043 ◽

Cited By ~ 1

Author(s):

Khic-Houy Prang ◽

Rachel Canaway ◽

Marie Bismark ◽

David Dunt ◽

Margaret Kelaher

Keyword(s):

Emergency Department ◽

Time Series ◽

Interrupted Time Series ◽

Time Series Study ◽

Process Outcomes ◽

Healthcare Reforms ◽

The Impact ◽

Series Study

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Effect of an innovative community-based care model, the Monarch Centre, on postpartum length of stay: an interrupted time-series study

CMAJ Open ◽

10.9778/cmajo.20180033 ◽

2018 ◽

Vol 6 (3) ◽

pp. E261-E268 ◽

Cited By ~ 2

Author(s):

Ghislain Hardy ◽

Jo Ann Colas ◽

Deborah Weiss ◽

David Millar ◽

Alan Forster ◽

...

Keyword(s):

Time Series ◽

Length Of Stay ◽

Interrupted Time Series ◽

Care Model ◽

Community Based ◽

Time Series Study ◽

Series Study

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Pay for performance and hip fracture outcomes

The Bone & Joint Journal ◽

10.1302/0301-620x.101b8.bjj-2019-0173.r1 ◽

2019 ◽

Vol 101-B (8) ◽

pp. 1015-1023 ◽

Cited By ~ 26

Author(s):

D. Metcalfe ◽

C. K. Zogg ◽

A. Judge ◽

D. C. Perry ◽

B. Gabbe ◽

...

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Pay For Performance ◽

Interrupted Time Series ◽

High Morbidity ◽

Post Intervention ◽

Difference In Differences ◽

Data Set ◽

Series Study

Aims Hip fractures are associated with high morbidity, mortality, and costs. One strategy for improving outcomes is to incentivize hospitals to provide better quality of care. We aimed to determine whether a pay-for-performance initiative affected hip fracture outcomes in England by using Scotland, which did not participate in the scheme, as a control. Materials and Methods We undertook an interrupted time series study with data from all patients aged more than 60 years with a hip fracture in England (2000 to 2018) using the Hospital Episode Statistics Admitted Patient Care (HES APC) data set linked to national death registrations. Difference-in-differences (DID) analysis incorporating equivalent data from the Scottish Morbidity Record was used to control for secular trends. The outcomes were 30-day and 365-day mortality, 30-day re-admission, time to operation, and acute length of stay. Results There were 1 037 860 patients with a hip fracture in England and 116 594 in Scotland. Both 30-day (DID -1.7%; 95% confidence interval (CI) -2.0 to -1.2) and 365-day (-1.9%; 95% CI -2.5 to -1.3) mortality fell in England post-intervention when compared with outcomes in Scotland. There were 7600 fewer deaths between 2010 and 2016 that could be attributed to interventions driven by pay-for-performance. A pre-existing annual trend towards increased 30-day re-admissions in England was halted post-intervention. Significant reductions were observed in the time to operation and length of stay. Conclusion This study provides evidence that a pay-for-performance programme improved the outcomes after a hip fracture in England. Cite this article: Bone Joint J 2019;101-B:1015–1023.

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Quality of elderly-patient care: An interrupted time series study

International Journal of Nursing Practice ◽

10.1111/j.1440-172x.1996.tb00038.x ◽

1996 ◽

Vol 2 (3) ◽

pp. 129-137 ◽

Cited By ~ 6

Author(s):

Pirjo Laitinen ◽

Pirkko Meriläinen PhD ◽

Sirkka Sinkkonen PhD

Keyword(s):

Elderly Patient ◽

Time Series ◽

Patient Care ◽

Interrupted Time Series ◽

Time Series Study ◽

Series Study

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Faculty Opinions recommendation of Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717963447.793464518 ◽

2012 ◽

Author(s):

Chris Robertson

Keyword(s):

Staphylococcus Aureus ◽

Time Series ◽

Clostridium Difficile ◽

Hand Hygiene ◽

Clostridium Difficile Infection ◽

Interrupted Time Series ◽

England And Wales ◽

Time Series Study ◽

Series Study

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National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015

Journal of the American Heart Association ◽

10.1161/jaha.120.017208 ◽

2020 ◽

Vol 9 (20) ◽

Author(s):

Akshay Pendyal ◽

Craig Rothenberg ◽

Jean E. Scofi ◽

Harlan M. Krumholz ◽

Basmah Safdar ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Length Of Stay ◽

Real World ◽

The United States ◽

Emergency Department Care ◽

Care Processes ◽

Ed Visits

Background Despite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real‐world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11‐year period, from 2005 to 2015. Methods and Results We conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence‐based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same‐hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%–31% and 10%–27%, respectively). Conclusions National, real‐world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high‐intensity antiplatelet therapy, early invasive strategies, and regionalization of care.

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