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Evidence: ‘Between the Flags’ approach to recognising patient deterioration
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Evidence: ‘Between the Flags’ approach to recognising patient deterioration

by Will DunlopAugust 16, 2018no comment
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Diagnostic: In-house Ultrasound Training Program for EM Registrars

by Keith JoeJanuary 14, 2019no comment
Evidence: Scribes increase medical productivity and shorten patient emergency stays
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Evidence: Scribes increase medical productivity and shorten patient emergency stays

by Keith JoeFebruary 1, 2019no comment
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Innovation: Using Visual Analogue Scales to Measure Patient Experience

by Keith JoeFebruary 18, 2019no comment

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Evidence: Predict admission length of stay and mortality

by Will DunlopAugust 16, 2018no comment
stethoscope

The advent of electronic medical records improved how readily clinical staff can access patients’ health information and allows admitting physicians to view records of new patients while they are still being worked up in the emergency department. The record contains much more data than the clinical notes entered by doctors or allied health. The number and frequency distribution of past admissions or referrals, changes in baseline vital signs, patterns of pathology or radiology reports, and ward transfers are all points of data available for analysis in electronic medical records. Could an algorithm use these data to predict the length of stay for a given patient?or predict 7-day mortality?

Researchers in New South Wales and Victoria, Australia used electronic health record data to predict mortality, readmission and length of stay in real time with good accuracy. Data from over 32,000 patients between 2008 and 2010 were used to build a Bayesian predictive model, which was tested on retrospective data from 2011. Predictions gave probabilities of specific outcomes (discharged, still admitted, or dead) over each of the next 7 days. Predictions had an 86% accuracy within 24 hours of prediction with an average daily accuracy of 80% by the 7th day. Death could be predicted with 93% accuracy. The algorithm therefore gave a reasonably accurate trajectory for any given patient’s admission.

Each new entry to patients’ prompts a recalculation. Providing information to patients and their families can help give an idea of the duration of stay that can be anticipated. Predictions of long stays could be used to focus efforts on best treatment strategies and bed planning. An increased probability of 7-day mortality can trigger counselling services and discussion of end-of-life care. Such prediction models would also be greatly valuable in emergency departments.

Benefits:

  • Accurate predictions of patient trajectories over 7 days
  • Uses existing data in patients’ existing medical records
  • Encourages effective allocation of resources

Limitations:

  • Possibility for less experienced physicians becoming dependent on predictions
  • Risk of patient distress if information is misinterpreted

For more information:

  • See the original article in the Journal of the American Medical Informatics Association
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It’s hard to define exemplar or World Class Emergency Medicine because aspects exist in many departments, but are not all present in one. The Best of Emergency Medicine brings together the best of patent care, design, and technology. It draws from real world emergency medicine examples put forward by the people who live and breathe them; the people who really know what works and what doesn’t. In sharing that experience, the Emergency Medicine community as a whole can lift the standards of care.

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Most Popular

  • Evidence: ‘Between the Flags’ approach to recognising patient deterioration

    Evidence: ‘Between the Flags’ approach to recognising patient deterioration

    August 16, 2018
  • Diagnostic: In-house Ultrasound Training Program for EM Registrars

    Diagnostic: In-house Ultrasound Training Program for EM Registrars

    January 14, 2019
  • Evidence: Scribes increase medical productivity and shorten patient emergency stays

    Evidence: Scribes increase medical productivity and shorten patient emergency stays

    February 1, 2019
  • Innovation: Using Visual Analogue Scales to Measure Patient Experience

    Innovation: Using Visual Analogue Scales to Measure Patient Experience

    February 18, 2019
  • Perspective: Decontamination Isolation Resuscitation Room

    Perspective: Decontamination Isolation Resuscitation Room

    February 11, 2019
  • Innovation: Medical Scribes in Australian Emergency Departments

    Innovation: Medical Scribes in Australian Emergency Departments

    October 15, 2018

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