Minimal Impact of Implemented Early Warning Score and Best Practice Alert for Patient Deterioration.
Minimal Impact of Implemented Early Warning Score and Best Practice Alert for Patient Deterioration.
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DOI：
10.1097/ccm.0000000000003439
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发表时间：
2019-01
影响因子：
8.8
通讯作者：
Goldstein BA
中科院分区：
文献类型：
--
作者：
Bedoya AD;Clement ME;Phelan M;Steorts RC;O'Brien C;Goldstein BA
之前的研究已经研究了NEWS在预测住院恶化和死亡方面的表现，但在实施国家预警评分（NEWS）后，缺乏关于患者结局的数据。我们试图确定NEWS实施在临床环境中预测和预防患者恶化的有效性。回顾性队列研究三级护理学术机构和社区医院。在NEWS实施前的2014年3月1日至2015年2月28日期间至NEWS实施后的2015年8月1日至2016年7月31日期间住院的18岁或以上患者。在电子健康记录（EHR）和相关最佳做法警报中实施NEWS。在这项包含85，322例患者（NEWS实施前42，402例患者和NEWS实施后42，920例患者）的研究中，在NEWS实施后，ICU转移率或死亡率的主要结局没有变化，我们的学术和社区医院的校正HR分别为0.94（0.84，1.05）和0.90（0.77，1.05）。在研究期间，总共有175，357名BPA被解雇，BPA在社区医院的表现优于学术医院，并在12小时内预测事件，分别为7.4%和2.2%。用新生成的医院特定系数重新训练NEWS提高了模型性能。在我们的学术和社区医院，NEWS的性能特征较差，通常被一线护理人员忽视。因此，NEWS的实施对定义的临床结局没有明显影响。使用特定于站点的数据重新拟合模型提高了性能，并支持验证本地数据的预测模型。
Prior studies have looked at NEWS performance in predicting in-hospital deterioration and death, but data are lacking with respect to patient outcomes following implementation of National Early Warning Score (NEWS). We sought to determine the effectiveness of NEWS implementation on predicting and preventing patient deterioration in a clinical setting. Retrospective cohort study Tertiary care academic facility and a community hospital. Patients 18 years of age or older hospitalized from March 1, 2014 to February 28, 2015 during pre-implementation of NEWS to August 1, 2015 to July 31, 2016 after NEWS was implemented. Implementation of NEWS within the electronic health record (EHR) and associated best practice alert. In this study of 85,322 patients (42,402 patients pre-NEWS and 42,920 patients post-NEWS implementation) the primary outcome of rate of ICU transfer or death did not change after NEWS implementation, with adjusted HRs of 0.94 (0.84, 1.05) and 0.90 (0.77, 1.05) at our academic and community hospital respectively. In total, 175,357 BPAs fired during the study period, with the BPA performing better at the community hospital than the academic and predicting an event within 12 hours 7.4% versus 2.2% of the time, respectively. Re-training NEWS with newly generated hospital-specific coefficients improved model performance. At both our academic and community hospital, NEWS had poor performance characteristics and was generally ignored by frontline nursing staff. As a result, NEWS implementation had no appreciable impact on defined clinical outcomes. Refitting of the model using site specific data improved performance and supports validating predictive models on local data.