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Veldhuis LI, van der Weide L, Nanayakkara P, Ludikhuize J. The accuracy of predicting hospital admission by emergency medical service and emergency department personnel compared to the prehospital MEWS: a prospective multicenter study. BMC Emerg Med 2024; 24:111. [PMID: 38982356 PMCID: PMC11234550 DOI: 10.1186/s12873-024-01031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Overcrowding in the emergency department (ED) is a global problem. Early and accurate recognition of a patient's disposition could limit time spend at the ED and thus improve throughput and quality of care provided. This study aims to compare the accuracy among healthcare providers and the prehospital Modified Early Warning Score (MEWS) in predicting the requirement for hospital admission. METHODS A prospective, observational, multi-centre study was performed including adult patients brought to the ED by ambulance. Involved Emergency Medical Service (EMS) personnel, ED nurses and physicians were asked to predict the need for hospital admission using a structured questionnaire. Primary endpoint was the comparison between the accuracy of healthcare providers and prehospital MEWS in predicting patients' need for hospital admission. RESULTS In total 798 patients were included of whom 393 (49.2%) were admitted to the hospital. Sensitivity of predicting hospital admission varied from 80.0 to 91.9%, with physicians predicting hospital admission significantly more accurately than EMS and ED nurses (p < 0.001). Specificity ranged from 56.4 to 67.0%. All healthcare providers outperformed MEWS ≥ 3 score on predicting hospital admission (sensitivity 80.0-91.9% versus 44.0%; all p < 0.001). Predictions for ward admissions specifically were significantly more accurate than MEWS (specificity 94.7-95.9% versus 60.6%, all p < 0.001). CONCLUSIONS Healthcare providers can accurately predict the need for hospital admission, and all providers outperformed the MEWS score.
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Affiliation(s)
- Lars I Veldhuis
- Emergency Department, Amsterdam UMC, Location Academic Medical Centre, Amsterdam, the Netherlands.
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Laura van der Weide
- Emergency Department, Amsterdam UMC, Location Academic Medical Centre, Amsterdam, the Netherlands
| | - Prabath Nanayakkara
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jeroen Ludikhuize
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Intensive Care medicine, HagaHospital, the Hague, the Netherlands
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Salter MD, Beaver S, Hasler L, Manivel V, Aziz O, Mallows JL. Determination of emergency nurse practitioner and plastic surgery trainee disposition decision agreement for plastic surgery emergency department presentations: A prospective study. Emerg Med Australas 2023; 35:739-745. [PMID: 36971043 DOI: 10.1111/1742-6723.14203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To examine if there was a high degree of agreement for disposition decisions of emergency nurse practitioners (ENP) compared to plastic surgery trainees (PST) for plastic surgery presentations. METHODS A prospective study of disposition decision agreement from February 2020 to January 2021 for patients who required plastic surgery consultation and managed exclusively by an ENP. Absolute percentages were used to determine the exact disposition decision accuracy of ENP and the PST, while Cohen's kappa compared disposition decision agreement. Sub-analyses of age, gender, ENP experience and presenting condition agreement were also completed. To mitigate confounding factors, operative management (OM) and non-OM groups were analysed. RESULTS The study recruited 342 patients who presented mostly with finger or hand-related conditions (82%, n = 279) and managed by an ENP with less than 10 years of experience (65%, n = 224). Disposition decisions by ENP compared to PST were the same in 80% (n = 274) of cases. Disposition agreement for all patients was 0.72 (95% confidence interval 0.66-0.78). For the OM and non-OM groups, disposition decisions were the same in 94% (n = 320), with a Cohen's kappa 0.85 (95% confidence interval 0.79-0.91). Seven patients (2%) were discharged to GP care by the ENP when determined to need further plastic surgery involvement by the PST. CONCLUSIONS Disposition decisions by ENP and PST were the same in most cases and had a high overall level of agreement. This may lead to greater autonomy of ENP care and reduced ED length of stay and occupancy.
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Affiliation(s)
- Mark D Salter
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
- The University of Sydney Nepean Clinical School, Sydney, New South Wales, Australia
| | - Sarah Beaver
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
| | - Linda Hasler
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
| | - Vijay Manivel
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
- The University of Sydney Nepean Clinical School, Sydney, New South Wales, Australia
| | - Omar Aziz
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
| | - James L Mallows
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
- The University of Sydney Nepean Clinical School, Sydney, New South Wales, Australia
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Leonard F, Gilligan J, Barrett MJ. Predicting Admissions From a Paediatric Emergency Department - Protocol for Developing and Validating a Low-Dimensional Machine Learning Prediction Model. Front Big Data 2021; 4:643558. [PMID: 33937750 PMCID: PMC8085432 DOI: 10.3389/fdata.2021.643558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/22/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Patients boarding in the Emergency Department can contribute to overcrowding, leading to longer waiting times and patients leaving without being seen or completing their treatment. The early identification of potential admissions could act as an additional decision support tool to alert clinicians that a patient needs to be reviewed for admission and would also be of benefit to bed managers in advance bed planning for the patient. We aim to create a low-dimensional model predicting admissions early from the paediatric Emergency Department. Methods and Analysis: The methodology Cross Industry Standard Process for Data Mining (CRISP-DM) will be followed. The dataset will comprise of 2 years of data, ~76,000 records. Potential predictors were identified from previous research, comprising of demographics, registration details, triage assessment, hospital usage and past medical history. Fifteen models will be developed comprised of 3 machine learning algorithms (Logistic regression, naïve Bayes and gradient boosting machine) and 5 sampling methods, 4 of which are aimed at addressing class imbalance (undersampling, oversampling, and synthetic oversampling techniques). The variables of importance will then be identified from the optimal model (selected based on the highest Area under the curve) and used to develop an additional low-dimensional model for deployment. Discussion: A low-dimensional model comprised of routinely collected data, captured up to post triage assessment would benefit many hospitals without data rich platforms for the development of models with a high number of predictors. Novel to the planned study is the use of data from the Republic of Ireland and the application of sampling techniques aimed at improving model performance impacted by an imbalance between admissions and discharges in the outcome variable.
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Affiliation(s)
- Fiona Leonard
- Business Intelligence Unit, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - John Gilligan
- School of Computer Science, Technological University Dublin, Dublin, Ireland
| | - Michael J Barrett
- Department of Emergency Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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Rutkowski RA, Salwei M, Barton H, Wust K, Hoonakker P, Brenny-Fitzpatrick M, King B, Shah MN, Pulia MS, Patterson BW, Dáil PVW, Smith M, Carayon P, Werner NE. Physician Perceptions of Disposition Decision-making for Older Adults in the Emergency Department: A Preliminary Analysis. ACTA ACUST UNITED AC 2021; 64:648-652. [PMID: 34234398 DOI: 10.1177/1071181320641148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disposition decision-making in the emergency department (ED) is critical to patient safety and quality of care. Disposition decision-making has particularly important implications for older adults who comprise a significant portion of ED visits annually and are vulnerable to suboptimal outcomes throughout ED care transitions. We conducted a secondary inductive content analysis of interviews with ED physicians (N= 11) to explore their perceptions of who they involve in disposition decision-making and what information they use to make disposition decisions for older adults. ED physicians cited 7 roles (5 types of clinicians, patients and families) and 11 information types, both clinical (e.g. test/lab results) and non-clinical (e.g. family's preference). Our preliminary findings represent a key first step toward the development of interventions that promote patient safety and quality of care for older adults in the ED by supporting the cognitive and communicative aspects of disposition decision-making.
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Affiliation(s)
- Rachel A Rutkowski
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Megan Salwei
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Hanna Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Kathryn Wust
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Peter Hoonakker
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | | | - Barbara King
- School of Nursing, University of Wisconsin-Madison
| | - Manish N Shah
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin-Madison
| | - Michael S Pulia
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin-Madison
| | - Brian W Patterson
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin-Madison
| | - Paula vW Dáil
- University of Wisconsin-Madison Health Sciences Patient and Family Advisory Council member
| | - Maureen Smith
- University of Wisconsin-Madison School of Medicine and Public Health, Departments of Population Health Sciences and Family Medicine & Community Health.,University of Wisconsin Institute of Clinical and Translational Research Health Innovation Program
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Nicole E Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
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Ratnovsky A, Rozenes S, Bloch E, Halpern P. Statistical learning methodologies and admission prediction in an emergency department. Australas Emerg Care 2021; 24:241-247. [PMID: 33461906 DOI: 10.1016/j.auec.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/07/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The quality of an emergency department (ED) is highly dependent on its ability to supply efficient, as well as high-quality treatment for all patients. Key performance indicators are important when measuring the performance of an emergency department. This study aimed to perform an exploratory data analysis and to develop an admission prediction model based on a dataset that was constructed from key performance indicators selected by a panel of expert physicians, nurses and hospital administrators. METHODS A dataset of 172,695 records was retrospectively collected from an Emergency Department. The relationships within the dataset were analyzed and three machine learning algorithms were compared for an admission predictive model based on the initial patient information. RESULTS The dataset showed that mean length of stay was similar in the different weekdays, there was a positive linear relationship between the length of stay and patient age and the admission predictive model yielded an AUC of 0.79. CONCLUSIONS The selected indicators can be used to study whether emergency department allocates its resources properly to cope with overcrowding and the predictive model may be employed by Hospital and ED administrates to fill information gaps and support decision making for the improvement of the key performance indicators.
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Affiliation(s)
- Anat Ratnovsky
- School of Medical Engineering, Afeka, Tel Aviv Academic College of Engineering, Israel.
| | - Shai Rozenes
- School of Industrial Engineering, Engineering and Management Programme, Afeka, Tel Aviv Academic College of Engineering, Israel
| | - Eli Bloch
- School of Industrial Engineering, Engineering and Management Programme, Afeka, Tel Aviv Academic College of Engineering, Israel
| | - Pinchas Halpern
- Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, and Tel Aviv University Sackler Faculty of Medicine, Israel
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Fortune telling: predicting hospital admissions to improve emergency department outflow. Eur J Emerg Med 2021; 28:77-78. [PMID: 33369955 DOI: 10.1097/mej.0000000000000740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zwank MD, Koops JJ, Adams NR. Provider-in-triage prediction of hospital admission after brief patient interaction. Am J Emerg Med 2020; 40:60-63. [PMID: 33348225 DOI: 10.1016/j.ajem.2020.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/09/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We sought to determine if emergency physician providers working in the triage area (PIT) of the ED could accurately predict the likelihood of admission for patients at the time of triage. Such predictions, if accurate, could decrease the time spent in the ED for patients who are admitted to the hospital by hastening downstream workflow. METHODS This is a prospective cohort study of PIT providers at a large urban hospital. Physicians were asked to predict the likelihood of admission and confidence of prediction for patients after evaluating them in triage. Measures of predictive accuracy were calculated, including sensitivity, specificity, and area under the receiver operator characteristic (AUROC). RESULTS 36 physicians (20 attendings, 16 residents) evaluated 340 patients and made predictions. The average patient age was 48 (range 18-94) and 52% were female. Seventy-three patients (21%) were admitted (5% observation, 85% general care/telemetry, 7% progressive care, 3% ICU). The sensitivity of determining admission for the entire cohort was 74%, the specificity was 84%, and the AUROC was 0.81. When physicians were at least 80% confident in their predictions, the predictions improved to sensitivity of 93%, specificity of 96%, and AUROC 0.95 (Graph 1). CONCLUSION The accuracy of physician providers-in-triage of predicting hospital admission was very good when those predictions were made with higher degrees of confidence. These results indicate that while general predictions of admission are likely inadequate to guide downstream workflow, predictions in which the physician is confident could provide utility.
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Affiliation(s)
| | - Jenny J Koops
- Regions Hospital, Saint Paul, MN, United States of America
| | - Nell R Adams
- Regions Hospital, Saint Paul, MN, United States of America
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Afnan MAM, Netke T, Singh P, Worthington H, Ali F, Kajamuhan C, Nagra A. Ability of triage nurses to predict, at the time of triage, the eventual disposition of patients attending the emergency department (ED): a systematic literature review and meta-analysis. Emerg Med J 2020; 38:694-700. [DOI: 10.1136/emermed-2019-208910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 05/03/2020] [Accepted: 05/08/2020] [Indexed: 11/03/2022]
Abstract
IntroductionExit block is the most significant cause of poor patient flow and crowding in the emergency department (ED). One proposed strategy to reduce exit block is early admission predictions by triage nurses to allow proactive bed management. We report a systematic review and meta-analysis of the accuracy of nurse prediction of admission at triage.MethodologyWe searched MEDLINE, Cochrane, Embase, CINAHL and grey literature, up to and including February 2019. Our criteria were as follows: prospective studies analysing the accuracy of triage nurse intuition—after gathering standard triage information—for predicting disposition for adult ED patients. We analysed the results of this test—nurse prediction of disposition—in a diagnostic test analysis review style, assessing methodology with the Quality Assessment of Diagnostic Accuracy Studies 2 checklist. We generated sensitivity, specificity and likelihood ratios (LRs). We used LRs and pretest probability of admission (baseline admission rate) to find positive and negative post-test probabilities.ResultsWe reviewed 10 articles. Of these, seven had meta-analysable data (12 282 participants). The studies varied in participant selection and admission rate, but the majority were of moderate quality and exclusion of each in sensitivity analyses made little difference. Sensitivity was 72% and specificity was 83%. Pretest probability of admission was 29%. Positive and negative post-test probabilities of admission were 63% and 12%, respectively.ConclusionTriage nurse prediction of disposition is not accurate enough to expedite admission for ED patients on a one-to-one basis. Future research should explore the benefit, and best method, of predicting total demand.
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Lee EEM, Kwok ESH, Vaillancourt C. Using emergency physicians’ abilities to predict patient admission to decrease admission delay time. Emerg Med J 2020; 37:417-422. [DOI: 10.1136/emermed-2019-208859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 01/09/2020] [Accepted: 01/27/2020] [Indexed: 11/03/2022]
Abstract
BackgroundIn many EDs, emergency physicians (EPs) do not have admitting privileges and must wait for consultants to further assess and admit patients. This delays bed requests and increases ED crowding. We measured EPs’ abilities to predict patient admission prior to consultation and estimated the potential ED stretcher time saved if EPs requested a bed with consultation.MethodsWe conducted a prospective cohort study in an academic centre in Canada between October 2017 and February 2018 using a convenience sample of ED patient encounters requiring consultation. We excluded patients under 18 years or those clearly likely to be admitted (traumas, strokes, S-T elevation myocardial infarctions and Canadian Triage and Acuity Scale of 1). EPs predicted patient admission just before consultation. Potential ED stretcher time saved was estimated for correctly predicted admissions assuming bed requests were initiated with consultation and a constant time to inpatient bed.ResultsCharacteristics of 454 patients were: mean age 60.1 years, 48.5% male, 46.9% evening presentation, 69.4% admitted and median time to bed request of 3.5 hours (IQR 2.0–5.3 hours). Overall, EPs prediction sensitivity, specificity, positive predictive value and negative predictive value were 90.5% (95% CI 86.7% to 93.5%), 84.2% (95% CI 77.0% to 89.8%), 92.8% (95% CI 89.8% to 95.0%) and 79.6% (95% CI 73.4% to 84.7%). Approximately 922.1 hours of ED stretcher time could have been saved during the 5-month study period if EPs initiated a bed request with consultation.ConclusionCrowding is a reality for EDs worldwide, and many systems could benefit from EP-initiated hospital admissions to decrease the amount of time admitted patients wait in the ED.
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Schütze H, Rees R, Asha S, Eagar K. Development and evaluation of a code frame to identify potential primary care presentations in the hospital emergency department. Emerg Med Australas 2019; 31:982-988. [PMID: 31050197 PMCID: PMC6916150 DOI: 10.1111/1742-6723.13293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE A major challenge in evaluating the appropriateness of ED presentations is the lack of a universal and workable definition of patients who could have received primary care instead. Our objective was to develop a standardised code frame to identify potential primary care patients in the ED. METHODS A standardised code frame to identify which patients could potentially be treated in a primary care setting was developed and tested on all patient episodes of care who presented to the ED of the St George Hospital, Sydney, between December 2016 and February 2017. Sensitivity and specificity of the code frame were performed. The code frame was then tested on all presentations from 2011 to 2016 in the St George Hospital and The Sutherland Hospital in Sydney. RESULTS Of 19 916 ED presentations, 5810 (29%) were potential primary care presentations. The code frame had a sensitivity of 99.9% and a specificity of 49.0%. Results were consistent (28%) when applied to 5 years of presentations (601 168 presentations). CONCLUSION This standardised code frame enables accurate retrospective local and national data estimations. The code frame could be used prospectively to evaluate interventions such as diverting patients to primary care settings, and to identify populations for specifically targeted interventions. The conservative nature of the code frame ensures that only those that can safely receive care in a primary care setting are identified as potential primary care.
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Affiliation(s)
- Heike Schütze
- School of Health and SocietyUniversity of WollongongWollongongNew South WalesAustralia
- Australian Health Services Research InstituteUniversity of WollongongWollongongNew South WalesAustralia
- St George HospitalSydneyNew South WalesAustralia
| | - Rhyannan Rees
- School of Health and SocietyUniversity of WollongongWollongongNew South WalesAustralia
- St George HospitalSydneyNew South WalesAustralia
| | - Stephen Asha
- St George HospitalSydneyNew South WalesAustralia
- St George Clinical SchoolThe University of New South WalesSydneyNew South WalesAustralia
| | - Kathy Eagar
- Australian Health Services Research InstituteUniversity of WollongongWollongongNew South WalesAustralia
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Bouzon Nagem Assad D, Spiegel T. Improving emergency department resource planning: a multiple case study. Health Syst (Basingstoke) 2019; 9:2-30. [DOI: 10.1080/20476965.2019.1680260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/10/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Daniel Bouzon Nagem Assad
- Departamento de Engenharia Industrial, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Organization Engineering, Business Administration and Statistics, Universidad Politécnica de Madrid, Madrid, Spain
| | - Thaís Spiegel
- Departamento de Engenharia Industrial, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Tootooni MS, Pasupathy KS, Heaton HA, Clements CM, Sir MY. CCMapper: An adaptive NLP-based free-text chief complaint mapping algorithm. Comput Biol Med 2019; 113:103398. [PMID: 31454613 DOI: 10.1016/j.compbiomed.2019.103398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Chief complaint (CC) is among the earliest health information recorded at the beginning of a patient's visit to an emergency department (ED). We propose a heuristic methodology for automatically mapping the free-text data into a structured list of CCs. METHODS A comprehensive structured list categorizing CCs was developed by experienced Emergency Medicine (EM) physicians. Using this list, we developed a natural language processing-based algorithm, referred to as Chief Complaint Mapper (CCMapper), for automatically mapping a CC into the most appropriate category (ies). We trained and validated CCMapper using free-text CC data from the Mayo Clinic ED in Rochester, MN. We developed a consensus-based validation approach to handle both indifferences and disagreements between the two EM physicians who manually mapped a random sample of free-text CCs into categories within the structured list. RESULTS The kappa statistic demonstrated a high level of agreement (κ = 0.958) between the two physicians with less than 2% human error. CCMapper achieved a total sensitivity of 94.2% with a specificity of 99.8% and F-score of 94.7% on the validation set. The sensitivity of CCMapper when mapping free-text data with multiple CCs was 82.3% with a specificity of 99.1% and total F-score of 82.3%. CONCLUSION Due to its simplicity, high performance, and capability of incorporating new free-text CC data, CCMapper can be readily adopted by other EDs to support clinical decision making. CCMapper can facilitate the development of predictive models for the type and timing of important events in ED (e.g., ICU admission).
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Affiliation(s)
- Mohammad Samie Tootooni
- Department of Health Informatics and Data Science, Loyola University Chicago, Maywood, IL, USA; Center for Health Outcomes and Informatics Research, Loyola University Chicago, Maywood, IL, USA.
| | - Kalyan S Pasupathy
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Heather A Heaton
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Casey M Clements
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Mustafa Y Sir
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
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Rabin E. Admission prediction rules: some limited promise, but far from proven. Emerg Med J 2018; 35:462-463. [DOI: 10.1136/emermed-2018-207759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 11/04/2022]
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Characterizing Potentially Preventable Admissions: A Mixed Methods Study of Rates, Associated Factors, Outcomes, and Physician Decision-Making. J Gen Intern Med 2018; 33:737-744. [PMID: 29340940 PMCID: PMC5910342 DOI: 10.1007/s11606-017-4285-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 09/29/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Potentially preventable admissions are a target for healthcare cost containment. OBJECTIVE To identify rates of, characterize associations with, and explore physician decision-making around potentially preventable admissions. DESIGN A comparative cohort study was used to determine rates of potentially preventable admissions and to identify associated factors and patient outcomes. A qualitative case study was used to explore physicians' clinical decision-making. PARTICIPANTS Patients admitted from the emergency department (ED) to the general medicine (GM) service over a total of 4 weeks were included as cases (N = 401). Physicians from both emergency medicine (EM) and GM that were involved in the cases were included (N = 82). APPROACH Physicians categorized admissions as potentially preventable. We examined differences in patient characteristics, admission characteristics, and patient outcomes between potentially preventable and control admissions. Interviews with participating physicians were conducted and transcribed. Transcriptions were systematically analyzed for key concepts regarding potentially preventable admissions. KEY RESULTS EM and GM physicians categorized 22.2% (90/401) of admissions as potentially preventable. There were no significant differences between potentially preventable and control admissions in patient or admission characteristics. Potentially preventable admissions had shorter length of stay (2.1 vs. 3.6 days, p < 0.001). There was no difference in other patient outcomes. Physicians discussed several provider, system, and patient factors that affected clinical decision-making around potentially preventable admissions, particularly in the "gray zone," including risk of deterioration at home, the risk of hospitalization, the cost to the patient, and the presence of outpatient resources. Differences in provider training, risk assessment, and provider understanding of outpatient access accounted for differences in decisions between EM and GM physicians. CONCLUSIONS Collaboration between EM and GM physicians around patients in the gray zone, focusing on patient risk, cost, and outpatient resources, may provide an avenues for reducing potentially preventable admissions and lowering healthcare spending.
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Shetty AL, Teh C, Vukasovic M, Joyce S, Vaghasiya MR, Forero R. Impact of emergency department discharge stream short stay unit performance and hospital bed occupancy rates on access and patient flowmeasures: A single site study. Emerg Med Australas 2017; 29:407-414. [DOI: 10.1111/1742-6723.12777] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/19/2017] [Accepted: 02/20/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Amith L Shetty
- Emergency Department; Westmead Hospital; Sydney New South Wales Australia
- Sydney Medical School - Westmead Campus, The University of Sydney; Sydney New South Wales Australia
| | - Caleb Teh
- The Sydney Children's Hospitals Network, The Children's Hospital at Westmead; Sydney New South Wales Australia
| | - Matthew Vukasovic
- Emergency Department; Westmead Hospital; Sydney New South Wales Australia
| | - Shannon Joyce
- Emergency Department; Westmead Hospital; Sydney New South Wales Australia
| | - Milan R Vaghasiya
- Emergency Department; Westmead Hospital; Sydney New South Wales Australia
| | - Roberto Forero
- Health Services Planning, Simpson Centre for Health Services Research, South Western Sydney Clinical School; The University of New South Wales; Sydney New South Wales Australia
- The Ingham Institute for Applied Research; Liverpool Hospital; Liverpool New South Wales Australia
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Barak-Corren Y, Israelit SH, Reis BY. Progressive prediction of hospitalisation in the emergency department: uncovering hidden patterns to improve patient flow. Emerg Med J 2017; 34:308-314. [DOI: 10.1136/emermed-2014-203819] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 09/21/2016] [Accepted: 01/01/2017] [Indexed: 11/04/2022]
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Dinh MM, Russell SB, Bein KJ, Rogers K, Muscatello D, Paoloni R, Hayman J, Chalkley DR, Ivers R. The Sydney Triage to Admission Risk Tool (START) to predict Emergency Department Disposition: A derivation and internal validation study using retrospective state-wide data from New South Wales, Australia. BMC Emerg Med 2016; 16:46. [PMID: 27912757 PMCID: PMC5135778 DOI: 10.1186/s12873-016-0111-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/26/2016] [Indexed: 11/10/2022] Open
Abstract
Background Disposition decisions are critical to the functioning of Emergency Departments. The objectives of the present study were to derive and internally validate a prediction model for inpatient admission from the Emergency Department to assist with triage, patient flow and clinical decision making. Methods This was a retrospective analysis of State-wide Emergency Department data in New South Wales, Australia. Adult patients (age ≥ 16 years) were included if they presented to a Level five or six (tertiary level) Emergency Department in New South Wales, Australia between 2013 and 2014. The outcome of interest was in-patient admission from the Emergency Department. This included all admissions to short stay and medical assessment units and being transferred out to another hospital. Analyses were performed using logistic regression. Discrimination was assessed using area under curve and derived risk scores were plotted to assess calibration. Results 1,721,294 presentations from twenty three Level five or six hospitals were analysed. Of these 49.38% were male and the mean (sd) age was 49.85 years (22.13). Level 6 hospitals accounted for 47.70% of cases and 40.74% of cases were classified as an in-patient admission based on their mode of separation. The final multivariable model including age, arrival by ambulance, triage category, previous admission and presenting problem had an AUC of 0.82 (95% CI 0.81, 0.82). Conclusion By deriving and internally validating a risk score model to predict the need for in-patient admission based on basic demographic and triage characteristics, patient flow in ED, clinical decision making and overall quality of care may be improved. Further studies are now required to establish clinical effectiveness of this risk score model.
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Affiliation(s)
- Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. .,Discipline of Emergency Medicine, The University of Sydney, Sydney, NSW, Australia. .,Emergency Department, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, 2050, Australia.
| | - Saartje Berendsen Russell
- Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Nursing, The University of Sydney, Sydney, NSW, Australia
| | - Kendall J Bein
- Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kris Rogers
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | - David Muscatello
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Richard Paoloni
- Discipline of Emergency Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Jon Hayman
- Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Health Education and Training Institute, New South Wales Ministry of Health, Sydney, NSW, Australia
| | - Dane R Chalkley
- Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia.,School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia
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