title: Automated detection of physiologic deterioration in hospitalized patients.
abstract: OBJECTIVE
  Develop and evaluate an automated case detection and response triggering system to monitor patients every 5 min and identify early signs of physiologic deterioration.
  
  
  METHODS
  A 2-year prospective, observational study at a large level 1 trauma center. All patients admitted to a 33-bed medical and oncology floor (A) and a 33-bed non-intensive care unit (ICU) surgical trauma floor (B) were monitored. During the intervention year, pager alerts of early physiologic deterioration were automatically sent to charge nurses along with access to a graphical point-of-care web page to facilitate patient evaluation.
  
  
  RESULTS
  Nurses reported the positive predictive value of alerts was 91-100% depending on erroneous data presence. Unit A patients were significantly older and had significantly more comorbidities than unit B patients. During the intervention year, unit A patients had a significant increase in length of stay, more transfers to ICU (p = 0.23), and significantly more medical emergency team (MET) calls (p = 0.0008), and significantly fewer died (p = 0.044) compared to the pre-intervention year. No significant differences were found on unit B.
  
  
  CONCLUSIONS
  We monitored patients every 5 min and provided automated pages of early physiologic deterioration. This before-after study found a significant increase in MET calls and a significant decrease in mortality only in the unit with older patients with multiple comorbidities, and thus further study is warranted to detect potential confounding. Moreover, nurses reported the graphical alerts provided information needed to quickly evaluate patients, and they felt more confident about their assessment and more comfortable requesting help.
authors.affiliation: Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: R Scott
authors.initials: RS
authors.lastname: Evans
authors.affiliation: Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA Pulmonary and Critical Care, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Kuttler
authors.affiliation: Shock Trauma Intensive Care, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Simpson
authors.affiliation: Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Howe
authors.affiliation: Pulmonary and Critical Care, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Crossno
authors.affiliation: Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA.
authors.forename: Kyle V
authors.initials: KV
authors.lastname: Johnson
authors.affiliation: Shock Trauma Intensive Care, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: Misty N
authors.initials: MN
authors.lastname: Schreiner
authors.affiliation: Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Lloyd
authors.affiliation: Hyperbaric Medicine, Wound Care & Infectious Diseases, Intermountain Healthcare, Salt Lake City, Utah, USA Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Tettelbach
authors.affiliation: Intensive Medicine/Emergency Services, Intermountain Healthcare, Salt Lake City, Utah, USA.
authors.forename: Roger K
authors.initials: RK
authors.lastname: Keddington
authors.affiliation: Shock Trauma Intensive Care, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: Alden
authors.initials: A
authors.lastname: Tanner
authors.affiliation: Shock Trauma Intensive Care, Intermountain Medical Center, Murray, Utah, USA.
authors.forename: Chelbi
authors.initials: C
authors.lastname: Wilde
authors.affiliation: Critical Care Medicine, LDS Hospital, Salt Lake City, Utah, USA Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Terry P
authors.initials: TP
authors.lastname: Clemmer
mesh_terms: D015897:Comorbidity; D020000:Decision Support Systems, Clinical; D018450:Disease Progression; D004630:Emergencies / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D009741:Nursing Staff, Hospital; D010348:Patient Care Team; D011446:Prospective Studies; D014193:Trauma Centers
keywords: Clinical Decision Support; medical emergency team; patient specific alerts; physiologic deterioration