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 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.

The effects of major depression disorder on neurogenic thoracic outlet syndrome surgery outcomes

Vascular ◽  
2021 ◽  
pp. 170853812110627
Author(s):  
Khaled I Alnahhal ◽  
Suhas Penukonda ◽  
Ranjana Lingutla ◽  
Ali Irshad ◽  
Genève M Allison ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Hospital Stay ◽  
Thoracic Outlet Syndrome ◽  
Surgical Intervention ◽  
Hospital Charges ◽  
Prolonged Hospital Stay ◽  
Total Hospital ◽  
Multivariable Logistic Regression ◽  
Prolonged Hospital ◽  
The Impact

Objectives Thoracic outlet syndrome (TOS) is a group of disorders caused by impingement of the neurovascular structures at the thoracic outlet. Neurogenic TOS (nTOS), which is thought to be caused by a compression of the brachial plexus, accounts for more than 90% of the cases. Although treatment for nTOS is successful through physiotherapy and/or surgical decompression, little is known about the impact of psychosocial factors, namely, major depressive disorder (MDD), on postoperative outcomes such as non-routine discharge (NRD). Here, we assess whether MDD predicts the type of discharge following nTOS surgical intervention. Methods A retrospective analysis of the National Inpatient Sample database from the years 2005–2018 was performed. Using the International Classification of Diseases Clinical Modification, Ninth and Tenth revisions, patients who underwent a surgical intervention for nTOS were identified. Our primary outcome was to investigate the effects of MDD on nTOS patient disposition status after surgical management; secondary outcomes included analysis of total hospital charges and length of stay. NRD was defined as anything beyond discharge home without healthcare services. Univariate and multivariable logistic regression analyses were conducted to assess MDD and other potential independent predictors of NRD and prolonged hospital stay (> 2 days) following surgical intervention. Results A total of 6099 patients were identified: 596 (9.77%) patients with MDD and 5503 (90.23%) without MDD. On average, patients with MDD were older (39.6 ± 12.0 years vs. 36.0 ± 13.0 years; p < 0.001), female (80.7% vs. 63.5%; p < 0.001), white (89.6% vs. 85.6%; p = 0.030), and on Medicare (9.6% vs 5.2%; p < 0.001). Univariate and multivariable logistic regression models identified MDD as an independent risk factor associated with a higher risk of NRD (adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI], 1.0–2.2). Additionally, chronic kidney disease (aOR, 2.60; 95% CI, 1.2–5.4), postoperative complications (aOR, 1.87; 95% CI, 1.2–2.9), and Medicare (aOR, 2.95; 95% CI, 1.9–4.7) were statistically significant predictors for higher risk of NRD. However, MDD was not associated with prolonged hospital stay (aOR, 1.00; 95% CI, 0.8–1.2) or higher median of total charges (MDD group: $27,867 vs. non-MDD group: $28,123; p = 0.799). Conclusion Comorbid MDD was strongly associated with higher NRD rates following nTOS surgical intervention. MDD had no significant impact on length of hospital stay or total hospital charges. Additional prospective research is necessary in order to better evaluate the impact of MDD in patients with nTOS.

scholarly journals The impact of complications on prolonged length of hospital stay after resection in colorectal cancer: A retrospective study of Taiwanese patients

2017 ◽  
Vol 45 (2) ◽  
pp. 691-705 ◽  
Author(s):  
Herng-Chia Chiu ◽  
Yi-Chieh Lin ◽  
Hui-Min Hsieh ◽  
Hsin-Pao Chen ◽  
Hui-Li Wang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Prolonged Hospital Stay ◽  
Prolonged Length ◽  
Regression Methods ◽  
Major Complications ◽  
Prolonged Hospital ◽  
The Impact

Objectives To assess the impact of minor, major and individual complications on prolonged length of hospital stay in patients with colorectal cancer (CRC) after surgery using multivariate models. Methods This was a retrospective review of data from patients who underwent surgery for stage I–III CRC at two medical centres in southern Taiwan between 2005–2010. Information was derived from four databases. Multivariate logistic regression methods were used to assess the impact of complications on prolonged length of stay (PLOS) and prolonged postoperative length of stay (PPOLOS). Results Of 1658 study patients, 251 (15.1%) experienced minor or major postsurgical complications during hospitalizations. Minor and major complications were significantly associated with PLOS (minor, odds ratio [OR] 3.59; major, OR 8.82) and with PPOLOS (minor, OR 5.55; major, OR 10.00). Intestinal obstruction, anastomosis leakage, abdominal abscess and bleeding produced the greatest impact. Conclusions Minor and major complications were stronger predictors of prolonged hospital stay than preoperative demographic and disease parameters. Compared with the PLOS model, the PPOLOS model better predicted risk of prolonged hospital stay. Optimal surgical and medical care have major roles in surgical CRC patients.

A study on the design of a wardrobe, for patients bed-ridden with cancer, applying the knowledge of anonymous design

Impact ◽  
2020 ◽  
Vol 2020 (7) ◽  
pp. 45-47
Author(s):  
Naoko Fujii
Keyword(s):  
Hospital Stay ◽  
Nursing Care ◽  
Healthcare Professionals ◽  
The Other ◽  
Human Beings ◽  
Prolonged Hospital Stay ◽  
Hospital Patients ◽  
Hospital Gowns ◽  
Hospital Stays ◽  
Prolonged Hospital

The majority of human beings will be admitted to hospital at some point over the course of their lives. For the more fortunate among us, these hospital stays will be brief and will barely register as a significant experience. However, for others, being admitted for weeks or months at a time will be necessary in order to combat and recover from whatever it was that made admittance to hospital necessary. While it is easy to think of many reasons why a prolonged hospital stay might be undesirable, one that may escape our attention is the clothes that are worn by patients during their stay. Once a patient has been assigned a bed, they are often given a gown which they put on without thought and then lie down. The gowns that are given to patients are generally designed with healthcare professionals in mind. For example, in Japan pyjamas and yukata (bathrobes) are used as hospital gowns because they have a front opening that is easy to use during treatment and nursing care. In addition, the other gowns can be opened from the ankle to the crotch using the zip. Dr Naoko Fujii has focused her career on designing clothes for hospital patients and believes that there is a way to satisfy the practical needs of a hospital and the care it gives at the same time as satisfying the requirements of patients. She is now focusing her attention on this challenge.

scholarly journals Current Evidence and Future Perspectives on the Effective Practice of Patient-Centered Laboratory Medicine

2015 ◽  
Vol 61 (4) ◽  
pp. 589-599 ◽  
Author(s):  
Mike J Hallworth ◽  
Paul L Epner ◽  
Christoph Ebert ◽  
Corinne R Fantz ◽  
Sherry A Faye ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Clinical Effectiveness ◽  
Laboratory Medicine ◽  
Current Evidence ◽  
Patient Centered ◽  
Definition Of ◽  
Current Utilization ◽  
Measures Of Effectiveness ◽  
The Impact ◽  
Primary Measure

AbstractBACKGROUNDSystematic evidence of the contribution made by laboratory medicine to patient outcomes and the overall process of healthcare is difficult to find. An understanding of the value of laboratory medicine, how it can be determined, and the various factors that influence it is vital to ensuring that the service is provided and used optimally.CONTENTThis review summarizes existing evidence supporting the impact of laboratory medicine in healthcare and indicates the gaps in our understanding. It also identifies deficiencies in current utilization, suggests potential solutions, and offers a vision of a future in which laboratory medicine is used optimally to support patient care.SUMMARYTo maximize the value of laboratory medicine, work is required in 5 areas: (a) improved utilization of existing and new tests; (b) definition of new roles for laboratory professionals that are focused on optimizing patient outcomes by adding value at all points of the diagnostic brain-to-brain cycle; (c) development of standardized protocols for prospective patient-centered studies of biomarker clinical effectiveness or extraanalytical process effectiveness; (d) benchmarking of existing and new tests in specified situations with commonly accepted measures of effectiveness; (e) agreed definition and validation of effectiveness measures and use of checklists for articles submitted for publication. Progress in these areas is essential if we are to demonstrate and enhance the value of laboratory medicine and prevent valuable information being lost in meaningless data. This requires effective collaboration with clinicians, and a determination to accept patient outcome and patient experience as the primary measure of laboratory effectiveness.

scholarly journals COPD in patients after heart transplantation is associated with a prolonged hospital stay, early posttransplant atrial fibrillation, and impaired posttransplant survival

2018 ◽  
Vol Volume 10 ◽  
pp. 1359-1369 ◽  
Author(s):  
Rasmus Rivinius ◽  
Matthias Helmschrott ◽  
Arjang Ruhparwar ◽  
Bastian Schmack ◽  
Fabrice F. Darche ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Transplantation ◽  
Hospital Stay ◽  
Prolonged Hospital Stay ◽  
Prolonged Hospital
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