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Informatics and interaction: Applying human factors principles to optimize the design of clinical decision support for sepsis:

Published on May 13, 2019in Health Informatics Journal2.297
· DOI :10.1177/1460458219839623
Laura Schubel (MedStar Health), Danielle L Mosby (MedStar Health)+ 9 AuthorsKristen Miller3
Estimated H-index: 3
(MedStar Health)
Abstract
In caring for patients with sepsis, the current structure of electronic health record systems allows clinical providers access to raw patient data without imputation of its significance. There are ...
  • References (32)
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References32
Newest
#1Mikhail A. Dziadzko (Mayo Clinic)H-Index: 6
#2Andrew M. Harrison (Mayo Clinic)H-Index: 10
Last. Vitaly D Herasevich (Mayo Clinic)H-Index: 21
view all 6 authors...
Background The number of electronic health record (EHR)-based notifications continues to rise. One common method to deliver urgent and emergent notifications (alerts) is paging. Despite of wide presence of smartphones, the use of these devices for secure alerting remains a relatively new phenomenon.
2 CitationsSource
#1Robert C. Amland (Cerner)H-Index: 5
#2Kristin E. Hahn-Cover (University of Missouri Health System)H-Index: 1
Sepsis is an inflammatory response triggered by infection, with a high in-hospital mortality rate. Early recognition and treatment can reverse the inflammatory response, with evidence of improved patient outcomes. One challenge clinicians face is identifying the inflammatory syndrome against the background of the patient’s infectious illness and comorbidities. An approach to this problem is implementation of computerized early warning tools for sepsis. This multicenter retrospective study sought...
35 CitationsSource
#1Christopher W. Seymour (University of Pittsburgh)H-Index: 27
#2Vincent Liu (KP: Kaiser Permanente)H-Index: 19
Last. Derek C. Angus (University of Pittsburgh)H-Index: 96
view all 13 authors...
RESULTS In the primary cohort, 148 907 encounters had suspected infection (n = 74 453 derivation; n = 74 454 validation), of whom 6347 (4%) died. Among ICU encounters in the validation cohort (n = 7932 with suspected infection, of whom 1289 [16%] died), the predictive validity for in-hospital mortality was lower for SIRS (AUROC = 0.64; 95% CI, 0.62-0.66) and qSOFA (AUROC = 0.66; 95% CI, 0.64-0.68) vs SOFA (AUROC = 0.74; 95% CI, 0.73-0.76; P < .001 for both) or LODS (AUROC = 0.75; 95% CI, 0.73-0....
767 CitationsSource
#1Mervyn Singer (UCL: University College London)H-Index: 69
#2Clifford S. Deutschman (The Feinstein Institute for Medical Research)H-Index: 34
Last. Derek C. Angus (University of Pittsburgh)H-Index: 96
view all 19 authors...
Importance Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination. Objective To evaluate and, as needed, update definitions for sepsis and septic shock. Process A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epide...
3,598 CitationsSource
#1Kristen Miller (Christiana Care Health System)H-Index: 3
#2Muge Capan (Christiana Care Health System)H-Index: 5
Last. Ryan Arnold (Christiana Care Health System)H-Index: 4
view all 5 authors...
Kristen E. Miller, Muge Capan, Pan Wu, Eric V. Jackson, Jr., Ryan C. Arnold Value Institute at Christiana Care Health systemIt is vital that health care providers have the tools needed for early diagnosis and treatment of sepsis to achieve improved survival outcomes. Despite advances in early warning system technology, providers still lack responsiveness in recognizing and treating septic patients. The recently introduced Centers for Medicare and Medicaid Services early management bundle for sev...
2 CitationsSource
BACKGROUND The consensus definition of severe sepsis requires suspected or proven infection, organ failure, and signs that meet two or more criteria for the systemic inflammatory response syndrome (SIRS). We aimed to test the sensitivity, face validity, and construct validity of this approach. METHODS We studied data from patients from 172 intensive care units in Australia and New Zealand from 2000 through 2013. We identified patients with infection and organ failure and categorized them accordi...
394 CitationsSource
#1Laura McRee (SLU: Saint Louis University)H-Index: 2
#2Joanne L. Thanavaro (SLU: Saint Louis University)H-Index: 8
Last. Alice E Pasvogel (UA: University of Arizona)H-Index: 16
view all 5 authors...
Abstract Objectives To evaluate the effects of this EMR surveillance on sepsis, severe sepsis or septic shock outcomes in patients admitted to a medical telemetry unit, including length of hospital stay, patient discharge and mortality. Methods A retrospective review of pre- and post-implementation of a pilot electronic medical record (EMR) sepsis surveillance. Results Implementing EMR sepsis surveillance significantly improved home discharge (49.0% versus 25.3%, p p p Conclusion These results o...
16 CitationsSource
#1Shobha PhansalkarH-Index: 19
#2Marianne Zachariah (Partners HealthCare)H-Index: 2
Last. David W. Bates (Partners HealthCare)H-Index: 138
view all 6 authors...
Introduction Increasing the adoption of electronic health records (EHRs) with integrated clinical decision support (CDS) is a key initiative of the current US healthcare administration. High over-ride rates of CDS alerts strongly limit these potential benefits. As a result, EHR designers aspire to improve alert design to achieve better acceptance rates. In this study, we evaluated drug–drug interaction (DDI) alerts generated in EHRs and compared them for compliance with human factors principles....
28 CitationsSource
#1Su Q. Nguyen (UA: University of Alabama)H-Index: 1
#2Edwin Mwakalindile (UA: University of Alabama)H-Index: 1
Last. Henry E. Wang (UA: University of Alabama)H-Index: 41
view all 8 authors...
Background. While often first treated in the emergency department (ED), identification of sepsis is difficult. Electronic medical record (EMR) clinical decision tools offer a novel strategy for identifying patients with sepsis. The objective of this study was to test the accuracy of an EMR-based, automated sepsis identification system. Methods. We tested an EMR-based sepsis identification tool at a major academic, urban ED with 64,000 annual visits. The EMR system collected vital sign and labora...
35 CitationsSource
#1Rosy Tsopra (University of Paris)H-Index: 4
#2Jean-Philippe Jais (Paris V: Paris Descartes University)H-Index: 44
Last. Catherine Duclos (University of Paris)H-Index: 5
view all 4 authors...
Context It is important to consider the way in which information is presented by the interfaces of clinical decision support systems, to favor the adoption of these systems by physicians. Interface design can focus on decision processes (guided navigation) or usability principles. Objective The aim of this study was to compare these two approaches in terms of perceived usability, accuracy rate, and confidence in the system. Materials and methods We displayed clinical practice guidelines for anti...
24 CitationsSource
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