Early detection, prevention, and mitigation of critical illness outside intensive care settings

Abstract

Patients who deteriorate outside the intensive care unit (ICU) are known to have elevated mortality and morbidity. Rapid response teams (RRTs) were developed to address such deterioration. It has not been possible to establish that RRTs employing manual detection methods have definitively improved hospital outcomes. Because of this, automated early detection systems based on data from modern electronic medical records have been developed. This article attempts to establish a conceptual framework for early detection, prevention, and mitigation of critical illness in hospitalized patients outside the ICU. Taking a step back from the now voluminous clinical and statistical literature on early warning systems, this article focuses on definitional issues (What is early detection? What does it aim to detect, and how?). Particular attention is given to how early detection systems interface with patients who are near the end of life. Also addressed are problems of how one quantifies benefit, which includes consideration of downsides such as potential harms of early detection. Journal of Hospital Medicine 2016;11:S5–S10. © 2016 Society of Hospital Medicine

Prediction of RecurrentClostridium DifficileInfection Using Comprehensive Electronic Medical Records in an Integrated Healthcare Delivery System

“…The final set of 23 predictors incorporated in the 3 models was based on clinical grounds, statistical performance, data abstraction burden in settings without EMRs, and (for the fully automated models) current KPNC data availability. 15,16 …”

Computer-aided National Early Warning Score to predict the risk of sepsis following emergency medical admission to hospital: a model development and external validation study

“…The extent to which these changes to NEWS enhance our cNEWS models requires further investigation. A crucial next phase of this work is to field test cNEWS by carefully engineering it to build on the current use of NEWS in routine clinical practice 30,31 to see if it does support the earlier detection and treatment of sepsis in emergency medical patients without unintended adverse consequences.…”

Statistical Modeling and Aggregate‐Weighted Scoring Systems in Prediction of Mortality and ICU Transfer: A Systematic Review

“…As early as 1997, hospitals have used early warning systems (EWSs) to identify at-risk patients and proactively inform clinicians. 8 EWSs can predict a proportion of patients who are at risk for clinical deterioration (this benefit is measured with sensitivity) with the tradeoff that some alerts are false (as measured with positive predictive value [PPV] or its inverse, workup-to-detection ratio [WDR] [9][10][11] ). Historically, EWS tools were paper-based instruments designed for fast manual calculation by hospital staff.…”