Data-driven approach to Early Warning Score-based alert management.
Data-driven approach to Early Warning Score-based alert management.
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DOI：
10.1136/bmjoq-2017-000088
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发表时间：
2018
期刊：
影响因子：
1.4
通讯作者：
Arnold RC
中科院分区：
文献类型：
--
作者：
Capan M;Hoover S;Miller KE;Pal C;Glasgow JM;Jackson EV;Arnold RC
越来越多地采用带有集成警报系统的电子健康记录（EHR）是提高患者安全性的关键举措。考虑到各种动态变化的临床信息，设计EHR驱动的警报系统仍然是一个挑战，该系统在正确的时间为正确的患者通知正确的提供者，同时管理警报负担。本研究的目的是主动开发和评估系统警报生成方法，作为研究医院实施早期预警评分（EWS）的一部分。我们量化了基于EWS的临床警报系统对警报数量和频率的影响，使用三种不同的警报算法，包括一组在满足某些标准时触发和静音警报的标准。我们使用了2015年12月至2016年7月在研究医院的三个单位回顾性收集的EHR数据，包括普通医疗，老年人急诊护理和心力衰竭患者。我们通过早期识别临床恶化的机会比较了警报生成算法，同时主动估计单位和患者水平的警报负担。结果强调了护理位置严重性和患者特征上生成的警报的数量和频率的依赖性。基于EWS的警报算法有可能在集成到临床实践之前促进适当的警报管理。通过比较不同的算法关于警报频率和潜在的早期检测生理恶化的关键患者安全的机会，从这项研究的结果强调了警报系统的需要量身定制的患者和护理位置的需求，并告知替代EWS为基础的警报部署策略，以提高患者的安全。
Increasing adoption of electronic health records (EHRs) with integrated alerting systems is a key initiative for improving patient safety. Considering the variety of dynamically changing clinical information, it remains a challenge to design EHR-driven alerting systems that notify the right providers for the right patient at the right time while managing alert burden. The objective of this study is to proactively develop and evaluate a systematic alert-generating approach as part of the implementation of an Early Warning Score (EWS) at the study hospitals. We quantified the impact of an EWS-based clinical alert system on quantity and frequency of alerts using three different alert algorithms consisting of a set of criteria for triggering and muting alerts when certain criteria are satisfied. We used retrospectively collected EHRs data from December 2015 to July 2016 in three units at the study hospitals including general medical, acute care for the elderly and patients with heart failure. We compared the alert-generating algorithms by opportunity of early recognition of clinical deterioration while proactively estimating alert burden at a unit and patient level. Results highlighted the dependency of the number and frequency of alerts generated on the care location severity and patient characteristics. EWS-based alert algorithms have the potential to facilitate appropriate alert management prior to integration into clinical practice. By comparing different algorithms with regard to the alert frequency and potential early detection of physiological deterioration as key patient safety opportunities, findings from this study highlight the need for alert systems tailored to patient and care location needs, and inform alternative EWS-based alert deployment strategies to enhance patient safety.