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The Impact of Health Information Technology for Early Detection of Patient Deterioration on Mortality and Length of Stay in the Hospital Acute Care Setting: Systematic Review and Meta-Analysis*

Herasevich, Svetlana MD¹; Lipatov, Kirill MD²; Pinevich, Yuliya MD¹; Lindroth, Heidi PhD, RN^3,4; Tekin, Aysun MD¹; Herasevich, Vitaly MD, PhD¹; Pickering, Brian W. MB, BCh¹; Barwise, Amelia K. MB, BCh, BAO, PhD^2,5

Author Information

¹ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.

² Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.

³ Department of Nursing, Mayo Clinic, Rochester, MN.

⁴ Center for Health Innovation and Implementation Science, Center for Aging Research, School of Medicine, Indiana University, Indianapolis, IN.

⁵ Bioethics Research Program, Mayo Clinic, Rochester, MN.

*See also p. 1280.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Drs. Herasevich, Herasevich, and Barwise contributed to the design of the study. All authors contributed to acquisition, analysis, and interpretation of the data. Drs. Herasevich and Barwise drafted the article. All authors critically revised the article for important intellectual content and approved the final version of the article.

Dr. Pickering received funding from Ambient Clinical Analytics; he disclosed that he is a board member of Ambient Clinical Analytics; he received support for article research from the Agency for Healthcare Research and Quality. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: [email protected]

Critical Care Medicine 50(8):p 1198-1209, August 2022. | DOI: 10.1097/CCM.0000000000005554

Abstract

OBJECTIVE:

To evaluate the impact of health information technology (HIT) for early detection of patient deterioration on patient mortality and length of stay (LOS) in acute care hospital settings.

DATA SOURCES:

We searched MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from 1990 to January 19, 2021.

STUDY SELECTION:

We included studies that enrolled patients hospitalized on the floor, in the ICU, or admitted through the emergency department. Eligible studies compared HIT for early detection of patient deterioration with usual care and reported at least one end point of interest: hospital or ICU LOS or mortality at any time point.

DATA EXTRACTION:

Study data were abstracted by two independent reviewers using a standardized data extraction form.

DATA SYNTHESIS:

Random-effects meta-analysis was used to pool data. Among the 30 eligible studies, seven were randomized controlled trials (RCTs) and 23 were pre-post studies. Compared with usual care, HIT for early detection of patient deterioration was not associated with a reduction in hospital mortality or LOS in the meta-analyses of RCTs. In the meta-analyses of pre-post studies, HIT interventions demonstrated a significant association with improved hospital mortality for the entire study cohort (odds ratio, 0.78 [95% CI, 0.70–0.87]) and reduced hospital LOS overall.

CONCLUSIONS:

HIT for early detection of patient deterioration in acute care settings was not significantly associated with improved mortality or LOS in the meta-analyses of RCTs. In the meta-analyses of pre-post studies, HIT was associated with improved hospital mortality and LOS; however, these results should be interpreted with caution. The differences in patient outcomes between the findings of the RCTs and pre-post studies may be secondary to confounding caused by unmeasured improvements in practice and workflow over time.

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Article Keywords

Keywords
clinical decision support, electronic health record, electronic medical record, hospital mortality, informatics, length of stay, patient deterioration, systematic review

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The Impact of Health Information Technology for Early Detection of Patient Deterioration on Mortality and Length of Stay in the Hospital Acute Care Setting: Systematic Review and Meta-Analysis*