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Journal Article > Review
Taenzer AH, Pyke JB, McGrath SP. Anesthesiology. 2011;115:421-431.
Journal Article > Study
Effect of a pediatric early warning system on all-cause mortality in hospitalized pediatric patients.
Parshuram CS, Dryden-Palmer K, Farrell C, et al; Canadian Critical Care Trials Group and EPOCH Investigators. JAMA. 2018;319:1002-1012.
Identifying incipient clinical deterioration is a prerequisite for rapid response and prevention of harm for hospitalized patients. This study tested a bedside pediatric early warning system, which included an illness severity score, standardized documentation, and monitoring protocols. In a cluster-randomized trial in several high-income countries, implementation of the bundle did not result in decreased in-hospital mortality compared to usual care. The overall mortality rate in the study was less than 0.2%. The authors suggest that this unexpectedly low mortality rate may have made it difficult to detect differences in intervention versus control hospitals. A related editorial suggests that artificial intelligence should be used to identify clinical deterioration and that outcomes beyond mortality should be considered in their evaluation.
Ross C. STAT. May 13, 2019.
Nuisance alarms, interruptions, and insufficient staff availability can hinder effective monitoring and response to acute patient deterioration. This news article reports on how hospital logistics centers are working toward utilizing artificial intelligence to improve clinician response to alarms by proactively identifying hospitalized patients at the highest risk for heart failure to trigger emergency response teams when their condition rapidly declines.
Journal Article > Study
Romero-Brufau S, Gaines K, Nicolas CT, Johnson MG, Hickman J, Huddleston JM. JAMIA Open. 2019 Aug 28; [Epub ahead of print].
Early recognition of clinical deterioration, in order to promote rapid response, is a critical inpatient safety priority. This prospective observational study examined bedside nurses' perception of possible clinical deterioration as a predictor of subsequent clinical deterioration. Researchers scored nurse Worry Factor on a 5-point scale from 0 (no concern) to 4 (extreme concern). Higher concern for patient deterioration on the part of nurses was strongly associated with subsequent clinical deterioration and intensive care unit transfer. The authors conclude that nurse concern is a powerful predictor of deterioration and should be included in the electronic health record. A WebM&M commentary highlighted how early recognition of patient deterioration requires not only medical expertise but also collaboration and communication among providers.