Using System Inflammatory Response Syndrome as an Easy-to-Implement, Sustainable, and Automated Tool for All-Cause Deterioration Among Medical Inpatients

Fogerty, Robert L.; Sussman, L. Scott; Kenyon, Kathleen; Li, Fangyong; Sukumar, Nitin; Kliger, Alan S.; Acker, Kurt; Sankey, Christopher

doi:10.1097/pts.0000000000000463

Cited by 6 publications

(18 citation statements)

References 19 publications

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“…Six studies adopted models already developed and available in the literature 25 28 32 35 38 39. The remaining seven studies selected items using a combination of literature and clinical judgement27 34 37 or did not describe the method for selecting alert thresholds 36 40–42…”

Section: Resultsmentioning

confidence: 99%

“…Studies described their systems as: a Modified Early Warning Score (MEWS);38 39 41 the EWS;34 the National Early Warning Score (NEWS);35 a combination of the NEWS, the Chronic Respiratory EWS and a palliative care tool;28 the Central Manchester University National Health Service Foundation Trust EWS;42 and the Rothman Index 25. One study used the systemic inflammatory response syndrome criteria 40. A multisite study used a variety of EWS across various sites,36 while five studies reported customising an existing EWS for their institutions 27 31 32 34 37.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies used manual data entry for vital signs and lab results, whereby nurses were required to enter all information into the iEMR 24 25 27 30 32 37 42. Three studies used automated data sources, which collected vital signs directly from patient monitors and/or lab results from the iEMR 33 34 40. One study used automated iEMR data combined with patient demographics and pre-existing comorbidities 26.…”

Section: Resultsmentioning

confidence: 99%

“…All studies automatically calculated alerts. Seven studies used continuous calculation methods, without mention of the frequency of calculation 24 30 33–35 39 40. Two studies each used 5 min,31 32 hourly25 26 and 4 hourly25 26 recalculation rates.…”

Section: Resultsmentioning

confidence: 99%

“…Alerts were sent to charge nurses via pager,24 31 a crisis nurse via any available iEMR kiosks,27 and a remote monitoring nurse via the iEMR 26. Alerts directed to the RRT attending40 physician or director37 were sent via pager, and to the RRT nurse via mobile phone 30. One study used alerts to inform the RRT nurse of which patients to prospectively evaluate at the beginning of each 12-hour shift 25.…”

Section: Resultsmentioning

confidence: 99%

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A scoping review of real-time automated clinical deterioration alerts and evidence of impacts on hospitalised patient outcomes

et al. 2022

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BackgroundHospital patients experiencing clinical deterioration are at greater risk of adverse events. Monitoring patients through early warning systems is widespread, despite limited published evidence that they improve patient outcomes. Current limitations including infrequent or incorrect risk calculations may be mitigated by integration into electronic medical records. Our objective was to examine the impact on patient outcomes of systems for detecting and responding to real-time, automated alerts for clinical deterioration.MethodsThis review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. We searched Medline, CINAHL and Embase for articles implementing real-time, automated deterioration alerts in hospitalised adults evaluating one or more patient outcomes including intensive care unit admission, length of stay, in-hospital cardiopulmonary arrest and in-hospital death.ResultsOf 639 studies identified, 18 were included in this review. Most studies did not report statistically significant associations between alert implementation and better patient outcomes. Four studies reported statistically significant improvements in two or more patient outcomes, and were the only studies to directly involve the patient’s clinician. However, only one of these four studies was robust to existing trends in patient outcomes. Of the six studies using robust study designs, one reported a statistically significant improvement in patient outcomes; the rest did not detect differences.ConclusionsMost studies in this review did not detect improvements in patient outcomes following the implementation of real-time deterioration alerts. Future implementation studies should consider: directly involving the patient’s physician or a dedicated surveillance nurse in structured response protocols for deteriorating patients; the workflow of alert recipients; and incorporating model features into the decision process to improve clinical utility.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

A scoping review of real-time automated clinical deterioration alerts and evidence of impacts on hospitalised patient outcomes

et al. 2022

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The Impact of Health Information Technology for Early Detection of Patient Deterioration on Mortality and Length of Stay in the Hospital Acute Care Setting: Systematic Review and Meta-Analysis

Herasevich

Lipatov

Pinevich

et al. 2022

Critical Care Medicine

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Technologies used by nursing to predict clinical deterioration in hospitalized adults: a scoping review

et al. 2022

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Objective: to map the early clinical deterioration technologies used in nurses’ professional practice in the care of hospitalized adult patients. Methods: this is a scoping review, according to Joanna Briggs Institute Reviewer’s Manual, which seeks to map the main technologies for detecting early clinical deterioration of hospitalized patients available for use by nurses, summarizing them and indicating gaps in knowledge to be investigated. Results: twenty-seven studies were found. The most present variables in the technologies were vital signs, urinary output, awareness and risk scales, clinical examination and nurses’ judgment. The main outcomes were activation of rapid response teams, death, cardiac arrest and admission to critical care units. Final considerations: the study emphasizes the most accurate variables in patient clinical assessment, so that indicative signs of potential severity can be prioritized to guide health conducts aiming to intervene early in the face of ongoing clinical deterioration.

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Using System Inflammatory Response Syndrome as an Easy-to-Implement, Sustainable, and Automated Tool for All-Cause Deterioration Among Medical Inpatients

Abstract: Whereas the definition of sepsis moves away from SIRS, SIRS-based criteria may still have clinical benefit as an easy-to-automate detection tool for all-cause clinical deterioration among medical inpatients.

Cited by 6 publications

References 19 publications

A scoping review of real-time automated clinical deterioration alerts and evidence of impacts on hospitalised patient outcomes

A scoping review of real-time automated clinical deterioration alerts and evidence of impacts on hospitalised patient outcomes

The Impact of Health Information Technology for Early Detection of Patient Deterioration on Mortality and Length of Stay in the Hospital Acute Care Setting: Systematic Review and Meta-Analysis

Technologies used by nursing to predict clinical deterioration in hospitalized adults: a scoping review

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