Piloting Electronic Medical Record-Based Early Detection of Inpatient Deterioration in Community Hospitals
Piloting Electronic Medical Record-Based Early Detection of Inpatient Deterioration in Community Hospitals
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DOI：
10.1002/jhm.2652
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发表时间：
2016-11-01
影响因子：
2.6
通讯作者：
Kipnis, Patricia
中科院分区：
文献类型：
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作者：
Escobar, Gabriel J.;Turk, Benjamin J.;Kipnis, Patricia
在重症监护病房 (ICU) 以外的医院病情恶化的患者比直接入住 ICU 的患者死亡率和发病率更高。随着越来越多的医院部署全面的住院电子病历 (EMR)，通过自动化早期检测系统支持快速响应团队的尝试变得越来越频繁。我们的目的是描述部署早期检测系统所涉及的一些技术和操作挑战。这个 2 家医院试点项目设置在包含 21 家医院的综合医疗保健服务系统内，有 2 个目标。首先，它的目的是证明可以向住院医师实时提供严重程度评分和概率估计。其次，它的目的是找出需要解决的问题，以便在所有剩余医院部署预警系统。为了实现这些目标，我们首先通过分析风险调整结果来确定开发早期检测系统的基本原理。然后我们证明了 EMR 数据可以用来预测恶化。在解决了特定的组织任务（例如，定义对概率估计的临床反应）后，我们将一组方程实例化到一个 Java 应用程序中，该应用程序传输分数和概率估计，以便每 6 小时在商用 EMR 中显示它们。试点已取得成功，并已开始部署到其余医院。
Patients who deteriorate in the hospital outside the intensive care unit (ICU) have higher mortality and morbidity than those admitted directly to the ICU. As more hospitals deploy comprehensive inpatient electronic medical records (EMRs), attempts to support rapid response teams with automated early detection systems are becoming more frequent. We aimed to describe some of the technical and operational challenges involved in the deployment of an early detection system. This 2-hospital pilot, set within an integrated healthcare delivery system with 21 hospitals, had 2 objectives. First, it aimed to demonstrate that severity scores and probability estimates could be provided to hospitalists in real time. Second, it aimed to surface issues that would need to be addressed so that deployment of the early warning system could occur in all remaining hospitals. To achieve these objectives, we first established a rationale for the development of an early detection system through the analysis of risk-adjusted outcomes. We then demonstrated that EMR data could be employed to predict deteriorations. After addressing specific organizational mandates (eg, defining the clinical response to a probability estimate), we instantiated a set of equations into a Java application that transmits scores and probability estimates so that they are visible in a commercially available EMR every 6 hours. The pilot has been successful and deployment to the remaining hospitals has begun.