scholarly journals Design and Implementation of a Real-time Monitoring Platform for Optimal Sepsis Care in an Emergency Department: Observational Cohort Study

10.2196/26946 ◽  
2021 ◽  
Vol 23 (6) ◽  
pp. e26946
Author(s):  
Andy Hung-Yi Lee ◽  
Emily Aaronson ◽  
Kathryn A Hibbert ◽  
Micah H Flynn ◽  
Hayley Rutkey ◽  
...  
Keyword(s):  
Emergency Department ◽  
Real Time ◽  
Blood Cultures ◽  
Technical Development ◽  
Pilot Phase ◽  
Patient Identification ◽  
Active Monitoring ◽  
Bundled Care ◽  
Study Intervention ◽  
Sepsis Care

Background Sepsis is the leading cause of death in US hospitals. Compliance with bundled care, specifically serial lactates, blood cultures, and antibiotics, improves outcomes but is often delayed or missed altogether in a busy practice environment. Objective This study aims to design, implement, and validate a novel monitoring and alerting platform that provides real-time feedback to frontline emergency department (ED) providers regarding adherence to bundled care. Methods This single-center, prospective, observational study was conducted in three phases: the design and technical development phase to build an initial version of the platform; the pilot phase to test and refine the platform in the clinical setting; and the postpilot rollout phase to fully implement the study intervention. Results During the design and technical development, study team members and stakeholders identified the criteria for patient inclusion, selected bundle measures from the Center for Medicare and Medicaid Sepsis Core Measure for alerting, and defined alert thresholds, message content, delivery mechanisms, and recipients. Additional refinements were made based on 70 provider survey results during the pilot phase, including removing alerts for vasopressor initiation and modifying text in the pages to facilitate patient identification. During the 48 days of the postpilot rollout phase, 15,770 ED encounters were tracked and 711 patient encounters were included in the active monitoring cohort. In total, 634 pages were sent at a rate of 0.98 per attending physician shift. Overall, 38.3% (272/711) patients had at least one page. The missing bundle elements that triggered alerts included: antibiotics 41.6% (136/327), repeat lactate 32.4% (106/327), blood cultures 20.8% (68/327), and initial lactate 5.2% (17/327). Of the missing Sepsis Core Measures elements for which a page was sent, 38.2% (125/327) were successfully completed on time. Conclusions A real-time sepsis care monitoring and alerting platform was created for the ED environment. The high proportion of patients with at least one alert suggested the significant potential for such a platform to improve care, whereas the overall number of alerts per clinician suggested a low risk of alarm fatigue. The study intervention warrants a more rigorous evaluation to ensure that the added alerts lead to better outcomes for patients with sepsis.

scholarly journals Design and Implementation of a Real-time Monitoring Platform for Optimal Sepsis Care in an Emergency Department: Observational Cohort Study (Preprint)

2021 ◽  
Author(s):  
Andy Hung-Yi Lee ◽  
Emily Aaronson ◽  
Kathryn A Hibbert ◽  
Micah H Flynn ◽  
Hayley Rutkey ◽  
...  
Keyword(s):  
Emergency Department ◽  
Real Time ◽  
Blood Cultures ◽  
Technical Development ◽  
Pilot Phase ◽  
Patient Identification ◽  
Active Monitoring ◽  
Bundled Care ◽  
Study Intervention ◽  
Sepsis Care

BACKGROUND Sepsis is the leading cause of death in US hospitals. Compliance with bundled care, specifically serial lactates, blood cultures, and antibiotics, improves outcomes but is often delayed or missed altogether in a busy practice environment. OBJECTIVE This study aims to design, implement, and validate a novel monitoring and alerting platform that provides real-time feedback to frontline emergency department (ED) providers regarding adherence to bundled care. METHODS This single-center, prospective, observational study was conducted in three phases: the design and technical development phase to build an initial version of the platform; the pilot phase to test and refine the platform in the clinical setting; and the postpilot rollout phase to fully implement the study intervention. RESULTS During the design and technical development, study team members and stakeholders identified the criteria for patient inclusion, selected bundle measures from the Center for Medicare and Medicaid Sepsis Core Measure for alerting, and defined alert thresholds, message content, delivery mechanisms, and recipients. Additional refinements were made based on 70 provider survey results during the pilot phase, including removing alerts for vasopressor initiation and modifying text in the pages to facilitate patient identification. During the 48 days of the postpilot rollout phase, 15,770 ED encounters were tracked and 711 patient encounters were included in the active monitoring cohort. In total, 634 pages were sent at a rate of 0.98 per attending physician shift. Overall, 38.3% (272/711) patients had at least one page. The missing bundle elements that triggered alerts included: antibiotics 41.6% (136/327), repeat lactate 32.4% (106/327), blood cultures 20.8% (68/327), and initial lactate 5.2% (17/327). Of the missing Sepsis Core Measures elements for which a page was sent, 38.2% (125/327) were successfully completed on time. CONCLUSIONS A real-time sepsis care monitoring and alerting platform was created for the ED environment. The high proportion of patients with at least one alert suggested the significant potential for such a platform to improve care, whereas the overall number of alerts per clinician suggested a low risk of alarm fatigue. The study intervention warrants a more rigorous evaluation to ensure that the added alerts lead to better outcomes for patients with sepsis.

Designing and Evaluating a Real-Time Automated Patient Screening System in an Emergency Department (Preprint)

2019 ◽  
Author(s):  
Yizhao Ni ◽  
Monica Bermudez ◽  
Stephanie Kennebeck ◽  
Stacey Liddy-Hicks ◽  
Judith Dexheimer
Keyword(s):  
Machine Learning ◽  
Clinical Trial ◽  
Emergency Department ◽  
Clinical Trials ◽  
Real Time ◽  
Patient Identification ◽  
Post Evaluation ◽  
Patient Screening ◽  
Automated Screening ◽  
Quantitative Assessments

BACKGROUND One critical hurdle for clinical trial recruitment is the lack of an efficient method for identifying subjects who meet eligibility criteria. Given the large volume of data documented in electronic health records (EHRs), it is labor-intensive for the staff to screen relevant information, particularly within the time frame needed. To facilitate subject identification, we developed a natural language processing (NLP) and machine learning-based system, Automated Clinical Trial Eligibility Screener© (ACTES), which analyzed structured data and unstructured narratives automatically to determine patients' suitability for clinical trial enrollment. In this study, we integrated the ACTES into clinical practice to support real-time patient screening. OBJECTIVE Our objective was to evaluate the ACTES's impact on the institutional workflow prospectively and comprehensively. We hypothesized that compared with the manual screening process, using EHR-based automated screening would improve efficiency of patient identification, streamline patient recruitment workflow, and increase enrollment in clinical trials. METHODS The ACTES was fully integrated into the clinical research coordinator (CRC) workflow in the pediatric emergency department (ED) at Cincinnati Children's Hospital Medical Center. The system continuously analyzed EHR information for current ED patients and recommended potential candidates for clinical trials. Relevant patient eligibility information was presented in real-time on a dashboard available to CRCs to facilitate their recruitment. To assess the system's effectiveness, we performed a multidimensional, prospective evaluation for a 12-month period, including a time-and-motion study, quantitative assessments of enrollment, and post-evaluation usability surveys collected from the CRCs. RESULTS Compared to manual screening, use of ACTES reduced the patient screening time by 34% (P<0.0001). The saved time was redirected to other work-related activities that streamlined teamwork among the CRCs (P <0.05). The quantitative assessments showed that automated screening improved the numbers of subjects screened, approached and enrolled by more than 10%, suggesting the potential of ACTES in streamlining recruitment workflow. The post-evaluation surveys indicated that the system was a good computerized solution with satisfactory usability. CONCLUSIONS By leveraging NLP and machine learning technologies, the ACTES demonstrated good capacity for improving efficiency of patient identification. The quantitative assessments demonstrated the potential of ACTES in streamlining recruitment workflow and improving patient approach and enrollment. The post-evaluation surveys suggested that the system was a good computerized solution with satisfactory usability.

scholarly journals Chryseobacterium bacteraemia in a patient with heart failure: case report and literature review

2020 ◽  
Author(s):  
Taylor Wood ◽  
Antonio Abbate ◽  
Inna Tchoukina ◽  
Michael P Stevens
Keyword(s):  
Emergency Department ◽  
Human Infection ◽  
Blood Cultures ◽  
Vasopressor Therapy ◽  
Duration Of Treatment ◽  
Chryseobacterium Indologenes ◽  
Case Summary ◽  
Biventricular Failure ◽  
Heart Failure Case ◽  
Antimicrobial Regimen

Abstract Background A 29-year-old male with recently diagnosed biventricular failure from myopericarditis and subsequent constrictive pericarditis on home milrinone presented to the Emergency Department with fevers/chills. Case summary On arrival to the Emergency Department, he was found to have septic shock and required vasopressor therapy. Chryseobacterium indologenes grew on his admission blood cultures, and he was treated with ciprofloxacin and piperacillin/tazobactam. He quickly improved, allowing for a successful pericardiectomy, was weaned off inotropes and discharged from the hospital. Discussion Chryseobacterium indologenes is an environmental Gram-negative rod found in groundwater. It is rarely associated with human infection, but is associated with indwelling lines and has been documented in immunocompromised patients. Treatment typically involves line removal and a fluoroquinolone or piperacillin/tazobactam; the most optimal antimicrobial regimen and duration of treatment are unknown.

Prospective real-time evaluation of the QTc interval variation after low-dose droperidol among emergency department patients

2021 ◽  
Author(s):  
Luis Hernández-Rodríguez ◽  
Fernanda Bellolio ◽  
Daniel Cabrera ◽  
Alicia E. Mattson ◽  
Derek VanMeter ◽  
...  
Keyword(s):  
Emergency Department ◽  
Real Time ◽  
Low Dose ◽  
Qtc Interval ◽  
Emergency Department Patients ◽  
Time Evaluation

The Waiting Room Assessment to Virtual Emergency Department pathway: Initiating video-based telemedicine in the pediatric emergency department

2021 ◽  
pp. 1357633X2110440
Author(s):  
Esli Osmanlliu ◽  
Isabelle Gagnon ◽  
Saskia Weber ◽  
Chi Quan Bach ◽  
Jennifer Turnbull ◽  
...  
Keyword(s):  
Emergency Department ◽  
Care Delivery ◽  
Care Pathway ◽  
Clinical Pathways ◽  
A Priori ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Pilot Phase ◽  
Waiting Room ◽  
Hospital Pediatric

The COVID-19 pandemic has presented pediatric emergency departments with unique challenges, resulting in a heightened demand for adapted clinical pathways. In response to this need, the Montreal Children's Hospital pediatric emergency department introduced the WAVE (Waiting Room Assessment to Virtual Emergency Department) pathway, a video-based telemedicine pathway for selected non-critical patients, aiming to reduce safety issues related to emergency department overcrowding, while providing timely care to all children presenting and registering at our emergency department. The objective of the WAVE pilot phase was to evaluate the feasibility and acceptability of telemedicine in our pediatric emergency department, which was previously unfamiliar with this mode of care delivery. During the six-week, three-evening per week deployment, we conducted 18 five-hour telemedicine shifts. In total, 27 patients participated in the WAVE pathway. Results from this pilot phase met four of five a priori feasibility and acceptability criteria. Overall, participating families were satisfied with this novel care pathway and reported no disruptive technological barriers.

Real-time video telemedicine applications in the emergency department: a scoping review of literature

CJEM ◽  
2017 ◽  
Vol 20 (6) ◽  
pp. 920-928 ◽  
Author(s):  
Danielle K. Kelton ◽  
Adam Szulewski ◽  
Daniel Howes
Keyword(s):  
Emergency Department ◽  
Real Time ◽  
Scoping Review ◽  
Exclusion Criteria ◽  
Current State ◽  
Study Selection ◽  
Cochrane Database ◽  
The World ◽  
Data Source ◽  
Widespread Interest

AbstractObjectivesTo collect and synthesize the literature describing the use of real-time video-based technologies to provide support in the care of patients presenting to emergency departments.Data SourceSix electronic databases were searched, including Medline, CINAHL, Embase, the Cochrane Database, DARE, and PubMed for all publications since the earliest date available in each database to February 2016.Study SelectionSelected articles were full text articles addressing the use of telemedicine to support patient care in pre-hospital or emergency department settings. The search yielded 2976 articles for review with 11 studies eligible for inclusion after application of the inclusion and exclusion criteria. A scoping review of the selected articles was performed to better understand the different systems in place around the world and the current state of evidence supporting telemedicine use in the emergency department.ConclusionsTelemedicine support for emergency department physicians is an application with significant potential but is still lacking evidence supporting improved patient outcomes. Advances in technology, combined with more attractive price-points have resulted in widespread interest and implementation around the world. Applications of this technology that are currently being studied include support for minor treatment centres, patient transfer decision-making, management of acutely ill patients and scheduled teleconsultations.

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