First name
Meghan
Last name
Galligan

Title

Leveraging EHR Data to Evaluate the Association of Late Recognition of Deterioration With Outcomes.

Year of Publication

2022

Number of Pages

447-460

Date Published

05/2022

ISSN Number

2154-1671

Abstract

OBJECTIVES: Emergency transfers (ETs), deterioration events with late recognition requiring ICU interventions within 1 hour of transfer, are associated with adverse outcomes. We leveraged electronic health record (EHR) data to assess the association between ETs and outcomes. We also evaluated the association between intervention timing (urgency) and outcomes.

METHODS: We conducted a propensity-score-matched study of hospitalized children requiring ICU transfer between 2015 and 2019 at a single institution. The primary exposure was ET, automatically classified using Epic Clarity Data stored in our enterprise data warehouse endotracheal tube in lines/drains/airway flowsheet, vasopressor in medication administration record, and/or ≥60 ml/kg intravenous fluids in intake/output flowsheets recorded within 1 hour of transfer. Urgent intervention was defined as interventions within 12 hours of transfer.

RESULTS: Of 2037 index transfers, 129 (6.3%) met ET criteria. In the propensity-score-matched cohort (127 ET, 374 matched controls), ET was associated with higher in-hospital mortality (13% vs 6.1%; odds ratio, 2.47; 95% confidence interval [95% CI], 1.24-4.9, P = .01), longer ICU length of stay (subdistribution hazard ratio of ICU discharge 0.74; 95% CI, 0.61-0.91, P < .01), and longer posttransfer length of stay (SHR of hospital discharge 0.71; 95% CI, 0.56-0.90, P < .01). Increased intervention urgency was associated with increased mortality risk: 4.1% no intervention, 6.4% urgent intervention, and 10% emergent intervention.

CONCLUSIONS: An EHR measure of deterioration with late recognition is associated with increased mortality and length of stay. Mortality risk increased with intervention urgency. Leveraging EHR automation facilitates generalizability, multicenter collaboratives, and metric consistency.

DOI

10.1542/hpeds.2021-006363

Alternate Title

Hosp Pediatr

PMID

35470399

Title

Leveraging EHR Data to Evaluate the Association of Late Recognition of Deterioration With Outcomes.

Year of Publication

2022

Number of Pages

447-460

Date Published

2022 May 01

ISSN Number

2154-1671

Abstract

<p><strong>OBJECTIVES: </strong>Emergency transfers (ETs), deterioration events with late recognition requiring ICU interventions within 1 hour of transfer, are associated with adverse outcomes. We leveraged electronic health record (EHR) data to assess the association between ETs and outcomes. We also evaluated the association between intervention timing (urgency) and outcomes.</p>

<p><strong>METHODS: </strong>We conducted a propensity-score-matched study of hospitalized children requiring ICU transfer between 2015 and 2019 at a single institution. The primary exposure was ET, automatically classified using Epic Clarity Data stored in our enterprise data warehouse endotracheal tube in lines/drains/airway flowsheet, vasopressor in medication administration record, and/or ≥60 ml/kg intravenous fluids in intake/output flowsheets recorded within 1 hour of transfer. Urgent intervention was defined as interventions within 12 hours of transfer.</p>

<p><strong>RESULTS: </strong>Of 2037 index transfers, 129 (6.3%) met ET criteria. In the propensity-score-matched cohort (127 ET, 374 matched controls), ET was associated with higher in-hospital mortality (13% vs 6.1%; odds ratio, 2.47; 95% confidence interval [95% CI], 1.24-4.9, P = .01), longer ICU length of stay (subdistribution hazard ratio of ICU discharge 0.74; 95% CI, 0.61-0.91, P &lt; .01), and longer posttransfer length of stay (SHR of hospital discharge 0.71; 95% CI, 0.56-0.90, P &lt; .01). Increased intervention urgency was associated with increased mortality risk: 4.1% no intervention, 6.4% urgent intervention, and 10% emergent intervention.</p>

<p><strong>CONCLUSIONS: </strong>An EHR measure of deterioration with late recognition is associated with increased mortality and length of stay. Mortality risk increased with intervention urgency. Leveraging EHR automation facilitates generalizability, multicenter collaboratives, and metric consistency.</p>

DOI

10.1542/hpeds.2021-006363

Alternate Title

Hosp Pediatr

PMID

35470399

Title

Interprofessional Team Member Communication Patterns, Teamwork, and Collaboration in Pre-Family Meeting Huddles in a Pediatric Cardiac Intensive Care Unit.

Year of Publication

2019

Date Published

2019 Apr 17

ISSN Number

1873-6513

Abstract

<p><strong>CONTEXT: </strong>Interprofessional teams often develop a care plan prior to engaging in a family meeting in the pediatric cardiac intensive care unit (CICU)-a process that can affect the course of the family meeting and alter team dynamics, but that has not been studied.</p>

<p><strong>OBJECTIVES: </strong>To characterize the types of interactions that interprofessional team members have in pre-family meetings huddles in the pediatric CICU by 1) evaluating the amount of time each team member speaks; 2) assessing team communication and teamwork using standardized instruments; and 3) measuring team members' perceptions of collaboration and satisfaction with decision-making.</p>

<p><strong>METHODS: </strong>We conducted a prospective observational study in a pediatric CICU. Subjects were members of the interprofessional team attending preparation meetings prior to care meetings with families of patients admitted to the CICU for longer than two weeks. We quantitatively coded the amount each team member spoke. We assessed team performance of communication and teamwork using the PACT-Novice tool, and we measured perception of collaboration and satisfaction with decision-making using the CSACD questionnaire.</p>

<p><strong>RESULTS: </strong>Physicians spoke for an average of 83.9% of each meeting's duration (SD 7.5%); non-physicians averaged 9.9% (SD 5.2%). Teamwork behaviors were present and adequately performed as judged by trained observers. Significant differences in physician and non-physician perceptions of collaboration were found in 3 out of 10 observed meetings.</p>

<p><strong>CONCLUSIONS: </strong>Interprofessional team members' interactions in team meetings provide important information about team dynamics, revealing potential opportunities for improved collaboration and communication in team meetings and subsequent family meetings.</p>

DOI

10.1016/j.jpainsymman.2019.04.009

Alternate Title

J Pain Symptom Manage

PMID

31004773

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