Protocol describing a systematic review and mixed methods consensus process to define the deteriorated ward patient

Abstract

IntroductionMost patients admitted to hospital recover with treatments that can be administered on the general ward. A small but important group deteriorate however and require augmented organ support in areas with increased nursing to patient ratios. In observational studies evaluating this cohort, proxy outcomes such as unplanned intensive care unit admission, cardiac arrest and death are used. These outcome measures introduce subjectivity and variability, which in turn hinders the development and accuracy of the increasing numbers of electronic medical record (EMR) linked digital tools designed to predict clinical deterioration. Here, we describe a protocol for developing a new outcome measure using mixed methods to address these limitations.Methods and analysisWe will undertake firstly, a systematic literature review to identify existing generic, syndrome-specific and organ-specific definitions for clinically deteriorated, hospitalised adult patients. Secondly, an international modified Delphi study to generate a short list of candidate definitions. Thirdly, a nominal group technique (NGT) (using a trained facilitator) will take a diverse group of stakeholders through a structured process to generate a consensus definition. The NGT process will be informed by the data generated from the first two stages. The definition(s) for the deteriorated ward patient will be readily extractable from the EMR.Ethics and disseminationThis study has ethics approval (reference 16399) from the Central Adelaide Local Health Network Human Research Ethics Committee. Results generated from this study will be disseminated through publication and presentation at national and international scientific meetings.

Artificial intelligence and clinical deterioration

“…A risk estimate of deterioration in the next 24 h was derived from these data. The risk estimate is then used to rank hospital ward patients from most to least likely to deteriorate in the coming 24 h. Using a combined outcome of IHCA and unplanned ICU admission, HAVEN has a c-statistic of 0.901 and, at a precision of 10%, was able to identify 42% of cardiac arrests with a lead time of 48 h. The algorithm development process was thorough, but it awaits implementation into clinical workflows [34][35][36][37][38][39].…”

A Protocol Describing A Scoping Review to Characterise ICU Admission Criteria

“…Presently, there is little agreement in the literature on criteria to define the deteriorated ward patient 11 and existing proxy measures of clinical deterioration – in-hospital mortality, in-hospital-cardiac-arrest (IHCA) and/or unplanned intensive care unit (ICU) transfer – have limitations which introduce subjectivity and variability to studies that use them as outcome measures. 4 The present study aims to better characterise how deterioration has been conceptualised/defined by clinicians in practice, in order to inform the development of alternate outcome measures. To do this, we will conduct a scoping review to identify criteria that have been used to determine when hospital inpatients are unwell enough to warrant admission to a higher acuity non-ward environment such as the intensive care unit (ICU) or high depency unit (HDU).…”