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Modified early warning score-based clinical decision support: cost impact and clinical outcomes in sepsis

OBJECTIVE: The objective of this study was to assess the clinical and financial impact of a quality improvement project that utilized a modified Early Warning Score (mEWS)-based clinical decision support intervention targeting early recognition of sepsis decompensation. MATERIALS AND METHODS: We con...

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Autores principales: Horton, Devin J, Graves, Kencee K, Kukhareva, Polina V, Johnson, Stacy A, Cedillo, Maribel, Sanford, Matthew, Dunson, William A, White, Michael, Roach, Dave, Arego, John J, Kawamoto, Kensaku
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382614/
https://www.ncbi.nlm.nih.gov/pubmed/32734167
http://dx.doi.org/10.1093/jamiaopen/ooaa014
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author Horton, Devin J
Graves, Kencee K
Kukhareva, Polina V
Johnson, Stacy A
Cedillo, Maribel
Sanford, Matthew
Dunson, William A
White, Michael
Roach, Dave
Arego, John J
Kawamoto, Kensaku
author_facet Horton, Devin J
Graves, Kencee K
Kukhareva, Polina V
Johnson, Stacy A
Cedillo, Maribel
Sanford, Matthew
Dunson, William A
White, Michael
Roach, Dave
Arego, John J
Kawamoto, Kensaku
author_sort Horton, Devin J
collection PubMed
description OBJECTIVE: The objective of this study was to assess the clinical and financial impact of a quality improvement project that utilized a modified Early Warning Score (mEWS)-based clinical decision support intervention targeting early recognition of sepsis decompensation. MATERIALS AND METHODS: We conducted a retrospective, interrupted time series study on all adult patients who received a diagnosis of sepsis and were exposed to an acute care floor with the intervention. Primary outcomes (total direct cost, length of stay [LOS], and mortality) were aggregated for each study month for the post-intervention period (March 1, 2016–February 28, 2017, n = 2118 visits) and compared to the pre-intervention period (November 1, 2014–October 31, 2015, n = 1546 visits). RESULTS: The intervention was associated with a decrease in median total direct cost and hospital LOS by 23% (P = .047) and .63 days (P = .059), respectively. There was no significant change in mortality. DISCUSSION: The implementation of an mEWS-based clinical decision support system in eight acute care floors at an academic medical center was associated with reduced total direct cost and LOS for patients hospitalized with sepsis. This was seen without an associated increase in intensive care unit utilization or broad-spectrum antibiotic use. CONCLUSION: An automated sepsis decompensation detection system has the potential to improve clinical and financial outcomes such as LOS and total direct cost. Further evaluation is needed to validate generalizability and to understand the relative importance of individual elements of the intervention.
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spelling pubmed-73826142020-07-29 Modified early warning score-based clinical decision support: cost impact and clinical outcomes in sepsis Horton, Devin J Graves, Kencee K Kukhareva, Polina V Johnson, Stacy A Cedillo, Maribel Sanford, Matthew Dunson, William A White, Michael Roach, Dave Arego, John J Kawamoto, Kensaku JAMIA Open Research and Applications OBJECTIVE: The objective of this study was to assess the clinical and financial impact of a quality improvement project that utilized a modified Early Warning Score (mEWS)-based clinical decision support intervention targeting early recognition of sepsis decompensation. MATERIALS AND METHODS: We conducted a retrospective, interrupted time series study on all adult patients who received a diagnosis of sepsis and were exposed to an acute care floor with the intervention. Primary outcomes (total direct cost, length of stay [LOS], and mortality) were aggregated for each study month for the post-intervention period (March 1, 2016–February 28, 2017, n = 2118 visits) and compared to the pre-intervention period (November 1, 2014–October 31, 2015, n = 1546 visits). RESULTS: The intervention was associated with a decrease in median total direct cost and hospital LOS by 23% (P = .047) and .63 days (P = .059), respectively. There was no significant change in mortality. DISCUSSION: The implementation of an mEWS-based clinical decision support system in eight acute care floors at an academic medical center was associated with reduced total direct cost and LOS for patients hospitalized with sepsis. This was seen without an associated increase in intensive care unit utilization or broad-spectrum antibiotic use. CONCLUSION: An automated sepsis decompensation detection system has the potential to improve clinical and financial outcomes such as LOS and total direct cost. Further evaluation is needed to validate generalizability and to understand the relative importance of individual elements of the intervention. Oxford University Press 2020-04-21 /pmc/articles/PMC7382614/ /pubmed/32734167 http://dx.doi.org/10.1093/jamiaopen/ooaa014 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of the American Medical Informatics Association. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Research and Applications
Horton, Devin J
Graves, Kencee K
Kukhareva, Polina V
Johnson, Stacy A
Cedillo, Maribel
Sanford, Matthew
Dunson, William A
White, Michael
Roach, Dave
Arego, John J
Kawamoto, Kensaku
Modified early warning score-based clinical decision support: cost impact and clinical outcomes in sepsis
title Modified early warning score-based clinical decision support: cost impact and clinical outcomes in sepsis
title_full Modified early warning score-based clinical decision support: cost impact and clinical outcomes in sepsis
title_fullStr Modified early warning score-based clinical decision support: cost impact and clinical outcomes in sepsis
title_full_unstemmed Modified early warning score-based clinical decision support: cost impact and clinical outcomes in sepsis
title_short Modified early warning score-based clinical decision support: cost impact and clinical outcomes in sepsis
title_sort modified early warning score-based clinical decision support: cost impact and clinical outcomes in sepsis
topic Research and Applications
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382614/
https://www.ncbi.nlm.nih.gov/pubmed/32734167
http://dx.doi.org/10.1093/jamiaopen/ooaa014
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