scholarly journals Identification of factors associated with morbidity and postoperative length of stay in surgically managed chronic subdural haematoma using electronic health records: a retrospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e037385 ◽  
Author(s):  
Daniel J Stubbs ◽  
Benjamin M Davies ◽  
Tom Bashford ◽  
Alexis J Joannides ◽  
Peter J Hutchinson ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Subdural Haematoma ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Chronic Subdural Haematoma ◽  
Electronic Health Record Data ◽  
Postoperative Stay ◽  
Intraoperative Management ◽  
Electronic Health ◽  
The Impact

IntroductionChronic subdural haematoma (cSDH) tends to occur in older patients, often with significant comorbidity. The incidence and effect of medical complications as well as the impact of intraoperative management strategies are now attracting increasing interest.ObjectivesWe used electronic health record data to study the profile of in-hospital morbidity and examine associations between various intraoperative events and postoperative stay.Design, setting and participantsSingle-centre, retrospective cohort of 530 cases of cSDH (2014–2019) surgically evacuated under general anaesthesia at a neurosciences centre in Cambridge, UK.Methods and outcome definitionComplications were defined using a modified Electronic Postoperative Morbidity Score. Association between complications and intraoperative care (time with mean arterial pressure <80 mm Hg, time outside of end-tidal carbon dioxide (ETCO2) range of 3–5 kPa, maintenance anaesthetic, operative time and opioid dose) on postoperative stay was assessed using Cox regression.Results53 (10%) patients suffered myocardial injury, while 24 (4.5%) suffered acute renal injury. On postoperative day 3 (D3), 280 (58% of remaining) inpatients suffered at least 1 complication. D7 rate was comparable (57%). Operative time was the only intraoperative event associated with postoperative stay (HR for discharge: 0.97 (95% CI: 0.95 to 0.99)). On multivariable analysis, postoperative complications (0.61 (0.55 to 0.68)), anticoagulation (0.45 (0.37 to 0.54)) and cognitive impairment (0.71 (0.58 to 0.87)) were associated with time to discharge.ConclusionsThere is a high postoperative morbidity burden in this cohort, which was associated with postoperative stay. We found no evidence of an association between intraoperative events and postoperative stay.

scholarly journals Secondary use of electronic health record data for clinical workflow analysis

2017 ◽  
Vol 25 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Michelle R Hribar ◽  
Sarah Read-Brown ◽  
Isaac H Goldstein ◽  
Leah G Reznick ◽  
Lorinna Lombardi ◽  
...  
Keyword(s):  
Simulation Models ◽  
Clinical Workflow ◽  
Electronic Health Record Data ◽  
Use Patterns ◽  
Secondary Use ◽  
Timing Data ◽  
Data Files ◽  
Electronic Health ◽  
Tracking Devices ◽  
The Impact

Abstract Objective Outpatient clinics lack guidance for tackling modern efficiency and productivity demands. Workflow studies require large amounts of timing data that are prohibitively expensive to collect through observation or tracking devices. Electronic health records (EHRs) contain a vast amount of timing data – timestamps collected during regular use – that can be mapped to workflow steps. This study validates using EHR timestamp data to predict outpatient ophthalmology clinic workflow timings at Oregon Health and Science University and demonstrates their usefulness in 3 different studies. Materials and Methods Four outpatient ophthalmology clinics were observed to determine their workflows and to time each workflow step. EHR timestamps were mapped to the workflow steps and validated against the observed timings. Results The EHR timestamp analysis produced times that were within 3 min of the observed times for &gt;80% of the appointments. EHR use patterns affected the accuracy of using EHR timestamps to predict workflow times. Discussion EHR timestamps provided a reasonable approximation of workflow and can be used for workflow studies. They can be used to create simulation models, analyze EHR use, and quantify the impact of trainees on workflow. Conclusion The secondary use of EHR timestamp data is a valuable resource for clinical workflow studies. Sample timestamp data files and algorithms for processing them are provided and can be used as a template for more studies in other clinical specialties and settings.

scholarly journals Stratifying risk for dementia onset using large‐scale electronic health record data: A retrospective cohort study

2020 ◽  
Vol 16 (3) ◽  
pp. 531-540 ◽  
Author(s):  
Thomas H. McCoy ◽  
Larry Han ◽  
Amelia M. Pellegrini ◽  
Rudolph E. Tanzi ◽  
Sabina Berretta ◽  
...  
Keyword(s):  
Cohort Study ◽  
Electronic Health Record ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Large Scale ◽  
Health Record ◽  
Electronic Health Record Data ◽  
Record Data ◽  
Electronic Health ◽  
Dementia Onset

scholarly journals The Impact of Disruption of the Care Delivery System by Commercial Laboratory Testing in a Children's Health Care System

2018 ◽  
Vol 143 (1) ◽  
pp. 115-121 ◽  
Author(s):  
Beverly B. Rogers ◽  
James L. Adams ◽  
Alexis B. Carter ◽  
Francine Uwindatwa ◽  
Cynthia B. Brawley ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Median Time ◽  
Laboratory Testing ◽  
Care Delivery ◽  
Reference Laboratory ◽  
Health Record ◽  
Multiple Sources ◽  
Electronic Health Record Data ◽  
Electronic Health ◽  
The Impact

Context.— Disruption of outpatient laboratory services by routing the samples to commercial reference laboratories may seem like a cost-saving measure by the payers, but results in hidden costs in quality and resources to support this paradigm. Objective.— To identify differences when outpatient tests are performed at the Children's Healthcare of Atlanta (Children's) Hospital lab compared to a commercial reference lab, and the financial costs to support the reference laboratory testing. Design.— Outpatient testing was sent to 3 different laboratories specified by the payer. Orders were placed in the Children's electronic health record, blood samples were drawn by the Children's phlebotomists, samples were sent to the testing laboratory, and results appeared in the electronic health record. Data comparing the time to result, cancelled samples, and cost to sustain the system of ordering and reporting were drawn from multiple sources, both electronic and manual. Results.— The median time from phlebotomy to result was 0.7 hours for testing at the Children's lab and 20.72 hours for the commercial lab. The median time from result posting to caregiver acknowledgment was 5.4 hours for the Children's lab and 18 hours for the commercial lab. The commercial lab cancelled 2.7% of the tests; the Children's lab cancelled 0.8%. The financial cost to support online ordering and reporting for testing performed at commercial labs was approximately $640,000 per year. Conclusions.— Tangible monetary costs, plus intangible costs related to delayed results, occur when the laboratory testing system is disrupted.

scholarly journals Visualization of Electronic Health Record Data for Decision-Making in Diabetes and Congestive Heart Failure

ACI Open ◽  
2020 ◽  
Vol 04 (01) ◽  
pp. e35-e43
Author(s):  
Shira H. Fischer ◽  
Charles Safran ◽  
Krzysztof Z. Gajos ◽  
Adam Wright
Keyword(s):  
Decision Making ◽  
Electronic Health Record ◽  
Primary Care Providers ◽  
Difficulty Level ◽  
Health Record ◽  
Care Providers ◽  
Electronic Health Record Data ◽  
Record Data ◽  
Electronic Health ◽  
The Impact

Abstract Objective The aim of this study is to study the impact of graphical representation of health record data on physician decision-making to inform the design of health information technology. Materials and Methods We conducted a within participants crossover design study using a simulated electronic health record (EHR) in which we presented cases with and without visualized data designed to highlight important clinical trends or relationships, followed by assessment of the impact on decision-making about next steps for patients with chronic diseases. We then asked whether trends were observed and about usability and satisfaction using validated usability questions and asked open-ended questions as well. Time to answer questions was also collected. Results Twenty-one primary care providers participated in the study, including five for testing only and sixteen for the full study. Questions about clinical assessment or next actions were answered correctly 55% of the time. Regarding objective trends in the data, participants described noticing the trends 85% of the time. Differences in noticing trends or difficulty level of questions were not statistically significant. Satisfaction with the tool was high and participants agreed strongly that it helped them make better decisions without adding to the time it took. Discussion The simulation allowed us to test the impact of a visualization on clinician practice in a realistic setting. Designers of EHRs should consider the ways information presentation can affect decision-making. Conclusion Testing visualization tools can be done in a clinically realistic context. Providers desire visualizations and believe that they help them make better and faster decisions.

Abstract P112: Impact Of Look Back Period Length On Associations When Using Electronic Health Record Data For Epidemiologic Research

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Nrupen A Bhavsar ◽  
John Pura ◽  
Ann Marie Navar ◽  
Anne Hellkamp ◽  
Paul Muntner ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Period Length ◽  
Health Record ◽  
Electronic Health Record Data ◽  
Glucose Lowering ◽  
Medicare Claims ◽  
Look Back ◽  
Electronic Health ◽  
The Impact

Introduction: Studies using electronic health record (EHR) data often have a limited number of years available for analysis. There is a trade off between the look back period length used to define baseline characteristics and follow up duration used to define outcomes. Objective: Quantify the impact of 6, 12, and 24 month look back periods on the association between diabetes (DM) and subsequent cardiovascular (CV) events using EHR data alone and in combination with Medicare claims. Methods: EHR data from an academic health system and a federally qualified health center from 2009-2014 were linked to Medicare claims data. Eligibility criteria were age ≥65 years, Durham County address, 24 months of continuous enrollment after first claim, EHR encounter in the 2011 index year, and no history of cardiovascular disease (CVD) in the 24 months prior to the index date (i.e., look back period). DM was defined using EHR ICD-9 codes, HbA1c ≥6.5%, or glucose lowering medication, and using claims based diagnosis codes or glucose lowering medication. The outcome was a major CV event (myocardial infarction, stroke, or cardiac procedure) defined by diagnosis or procedure codes. Hazard ratios (HR) compared time to the outcome between patients with and without DM. Results: In 5473 patients, mean age was 77 years, 67% were female and 28% were Black. The prevalence of DM using EHR data only increased with a longer look back period (6 months [19%]; 12 months [21%]; 24 months [23%]) but was less than the prevalence using all available data from EHRs and claims together (28%) (Table 1A). Shorter look back periods resulted in higher HRs (6 month HR=1.64) as compared to HRs from longer look back periods (24 month HR=1.41) using EHR data alone or all available data from the EHR and claims together (HR=1.43) (Table 1B). Conclusions: To avoid over estimating associations, studies of CVD using EHR data to identify baseline conditions may want to use 12-24 month look back periods in the absence of additional administrative data. This may also lead to a shorter follow-up period.

scholarly journals The use of atorvastatin for chronic subdural haematoma: a retrospective cohort comparison study

2016 ◽  
Vol 31 (1) ◽  
pp. 72-77 ◽  
Author(s):  
David Yuen Chung Chan ◽  
Danny Tat Ming Chan ◽  
Tin Fung David Sun ◽  
Stephanie Chi Ping Ng ◽  
George Kwok Chu Wong ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Subdural Haematoma ◽  
Chronic Subdural Haematoma ◽  
Comparison Study ◽  
Cohort Comparison

scholarly journals Chronic subdural haematoma during the COVID-19 lockdown period: late presentation with a longer interval from the initial head injury to the final presentation and diagnosis

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
David Yuen Chung Chan ◽  
Wai Sang Poon ◽  
Danny Tat Ming Chan ◽  
Wai Kit Mak ◽  
George Kwok Chu Wong
Keyword(s):  
Head Injury ◽  
Functional Outcome ◽  
Subdural Haematoma ◽  
Primary Outcome ◽  
The Elderly ◽  
Late Presentation ◽  
Chronic Subdural Haematoma ◽  
Significant Difference ◽  
Novel Coronavirus ◽  
The Impact

Abstract Background The COVID-19 novel coronavirus is contagious, and the mortality is higher in the elderly population. Lockdown in different parts of the world has been imposed since January 2020. Chronic subdural haematoma (cSDH) has a unique natural history in which symptoms can be non-specific, and the onset is insidious. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation of cSDH. Methods Consecutive adult cSDH patients admitted from 1 March 2020 to 30 April 2020 were reviewed. Exclusion criteria including those who had no definite history of head injury or the diagnosis of cSDH were made from a scheduled follow-up scan. Corresponding data during the same period in 2019 were reviewed for comparison. The primary outcome was the interval between the initial head injury and the final radiological diagnosis of cSDH. Secondary outcomes include Markwalder chronic subdural haematoma grade upon admission, length of stay in the acute hospital, and the modified Rankin scale (mRS) upon discharge. Results For the primary outcome, the average interval between head injury and the diagnosis of cSDH was significantly longer at 56.6 days (49 to 74 days, SD 9.83 days) during the period from March to April 2020, versus 29.4 days (17 to 42 days, SD 8.59 days) in 2019 for the corresponding period (p = 0.00703). There was no significant difference in the functional outcome upon discharge. Conclusions cSDH patients can present late during the COVID-19 lockdown period. The functional outcome was comparable when operations for drainage were timely performed.

scholarly journals Incidence of chronic subdural haematoma: a single-centre exploration of the effects of an ageing population with a review of the literature

2021 ◽  
Author(s):  
D. J. Stubbs ◽  
M. E. Vivian ◽  
B. M. Davies ◽  
A. Ercole ◽  
R. Burnstein ◽  
...  
Keyword(s):  
Subdural Haematoma ◽  
Incidence Rates ◽  
Chronic Subdural Haematoma ◽  
Population Projections ◽  
Ageing Population ◽  
Single Centre ◽  
Crude Incidence ◽  
Single Centre Study ◽  
The Uk ◽  
The Impact

Abstract Background Chronic subdural haematoma (cSDH) is a common neurosurgical pathology frequently occurring in older patients. The impact of population ageing on cSDH caseload has not been examined, despite relevance for health system planning. Methods This is a single-centre study from the UK. Operated cases of cSDH (n = 446) for 2015–2018 were identified. Crude and directly standardised incidence rates were calculated. Medline and EMBASE were systematically searched to identify studies reporting on the incidence of cSDH by year, so an estimate of rate of incidence change could be determined. Local incidence rates were then applied to population projections for local catchment area to estimate operated cSDH numbers at 5 yearly intervals due to shifting demographics. Results We identified nine studies presenting incidence estimates. Crude estimates for operative cases ranged from 1.3/100,000/year (1.4–2.2) to 5.3/100,000/year (4.3–6.6). When non-operated cases were included, incidence was higher: 8.2/100,000/year (6.0–11.2) to 48/100,000/year (37.7–61.1). Four pairs of studies demonstrated incidence rate increases of 200–600% over the last 50 years, but data was deemed too heterogeneous to generate formal estimate of incidence change. Local crude incidence of operated cSDH was 3.50/100,000/year (3.19–3.85). Directly standardised incidence was 1.58/100,000/year (1.26–1.90). After applying local incidence rates to population projections, case numbers were predicted to increase by 53% over the next 20 years. Conclusions The incidence of cSDH is increasing. We project a 53% increase in operative caseload within our region by 2040. These are important findings for guiding future healthcare planning.

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