Early Warning Systems: The Neglected Importance of Timing
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The implementation gap has largely been filled by commercial electronic health record vendors, who integrated early warning systems into the EHR.
“This gap has largely been filled by commercial electronic health record (EHR) vendors, who have integrated early warning systems into the EHR where they can be readily accessed by clinicians and linked to clinical interventions.12,13”
From External validation of a widely implemented proprietary sepsis prediction model in hospitalized patients (2021) · cites this paper as [12]
The opening section describes automated early warning systems and notifications to clinicians, but does not say that commercial EHR vendors filled an implementation gap. A reference title mentions an EHR-embedded sepsis alert; neither it nor the passages found by searching for vendor integration establish the claim about vendors. (LLM, conf=0.73)
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Cites
Rhee, C., Brown, S. R., Jones, T. M., O’Brien, C., Pande, A., Hamad, Y., Bulger, A. L., Tobin, K. A., Massaro, A. F., Anderson, D. J., et al. (2018) · Infection Control & Hospital Epidemiology · doi:10.1017/ice.2018.134 · Cited by 51 · see citing works
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Research works printed but not linked: 17
- The Lancet Respiratory Medicine. Crying wolf: the growing fatigue around sepsis alerts. Lancet Respir Med. 2018;6(3):161. doi: 10.1016/S2213- 2600(18)30072-9. · DOI
- Hooper MH, Weavind L, Wheeler AP, et al. Randomized trial of automat- ed, electronic monitoring to facilitate early detection of sepsis in the intensive care unit. Crit Care Med. 2012;40(7):2096-2101. doi: 10.1097/ CCM.0b013e318250a887. · DOI · Paper page
- Nelson JL, Smith BL, Jared JD, et al. Prospective trial of real-time electron- ic surveillance to expedite early care of severe sepsis. Ann Emerg Med. 2011;57(5):500-504. doi: 10.1016/j.annemergmed.2010.12.008. · DOI · Paper page
- Umscheid CA, Betesh J, VanZandbergen C, et al. Development, implemen- tation, and impact of an automated early warning and response system for sepsis. J Hosp Med. 2015;10(1):26-31. doi: 10.1002/jhm.2259. · DOI
- Kleinman KP, Abrams AM. Assessing surveillance using sensitivity, spec- ificity and timeliness. Stat Methods Med Res. 2006;15(5):445-464. doi: 10.1177/0962280206071641. · DOI
- Jiang X, Cooper GF, Neill DB. Generalized AMOC curves for evaluation and improvement of event surveillance. AMIA Annu Symp Proc. 2009;281-285.
- Futoma J, Hariharan S, Sendak M, et al. An improved multi-output Gaussian process RNN with real-time validation for early sepsis detection. In Proceed- ings of the 2nd Machine Learning for Healthcare Conference (MLHC), Bos- ton, MA, Aug 2017.
- Rolnick J, Downing N, Shepard J, et al. Validation of test performance and clinical time zero for an electronic health record embedded severe sepsis alert. Appl Clin Inform. 2016;7(2):560-572. doi: 10.4338/ACI-2015-11-RA-0159. · DOI
- DeVita MA, Smith GB, Adam SK, et al. "Identifying the hospitalised pa- tient in crisis"-A consensus conference on the afferent limb of rapid re- sponse systems. Resuscitation. 2010;81(4):375-382. doi: 10.1016/j.resuscita- tion.2009.12.008. · DOI
- Romero-Brufau S, Huddleston JM, Escobar GJ, et al. Why the C-statistic is not informative to evaluate early warning scores and what metrics to use. Crit Care. 2015;19(1):284-290. doi: 10.1186/s13054-015-0999-1. · DOI
- Evans IVR, Phillips GS, Alpern ER, et al. Association between the New York sepsis care mandate and in-hospital mortality for pediatric sepsis. JAMA. 2018;320(4):358-367. doi: 10.1001/jama.2018.9071. · DOI
- Daniels R, Nutbeam T, McNamara G, et al. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emerg Med J. 2011;28(6):507-512. doi: 10.1136/emj.2010.095067. · DOI
- Paul R, Melendez E, Wathen B, et al. A quality improvement collaborative for pediatric sepsis: lessons learned. Pediatr Qual Saf. 2018;3(1):1-8. doi: 10.1097/pq9.0000000000000051. · DOI
- Winter MC, Kubis S, Bonafide CP. Beyond reporting early warning score sensitivity: the temporal relationship and clinical relevance of "true positive" alerts that precede critical deterioration. J Hosp Med. 2019;14(3):138-143. doi: 10.12788/jhm.3066. · DOI
- Dummett BA, Adams C, Scruth E, et al. Incorporating an early detection sys- tem into routine clinical practice in two community hospitals: Incorporating an EWS into practice. J Hosp Med. 2016;11(51):S25-S31. doi: 10.1002/jhm.2661. · DOI
- Jolley RJ, Quan H, Jetté N, et al. Validation and optimisation of an ICD-10- coded case definition for sepsis using administrative health data. BMJ Open. 2015;5(12):e009487. doi: 10.1136/bmjopen-2015-009487. · DOI
- Wellner B, Grand J, Canzone E, et al. Predicting unplanned transfers to the intensive care unit: a machine learning approach leveraging diverse clinical elements. JMIR Med Inform. 2017;5(4):e45. doi: 10.2196/medinform.8680. · DOI
Cited by
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Wong, A., Otles, E., Donnelly, J. P., Krumm, A., McCullough, J., DeTroyer-Cooley, O., Pestrue, J., Phillips, M., Konye, J., Penoza, C., et al. (2021) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2021.2626 · Cited by 995 · see citing works
Evaluation of sepsis prediction models before onset of treatment
Kamran, F., Tjandra, D., Heiler, A., Virzi, J., Singh, K., King, J. E., Valley, T. S., & Wiens, J. (2024) · NEJM AI · doi:10.1056/aioa2300032 · Cited by 74 · see citing works
Topiwala, R., Patel, K., Twigg, J., Rhule, J., & Meisenberg, B. (2019) · Critical Care Explorations · doi:10.1097/cce.0000000000000046 · Cited by 16 · see citing works
- Authors
- Rolnick, J. A.
- Affiliations
- Philadelphia VA Medical Center (US)
- Corresponding author
- Rolnick, Joshua A
- ORCID
- Rolnick, Joshua A
- Venue
- Journal of Hospital Medicine
- Publisher
- Wiley
- Published
- 2019
- Volume
- 14
- Issue
- 7
- Pages
- 445
- ISSN
- 1553-5592 (ISSN-L)
- 1553-5606
- OpenAlex
- W2953710025
- Cited by
- 7
- References
- 1
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 1 · 2019: 1
- FWCI
- 1.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Hospital Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Surgery › Healthcare Technology and Patient Monitoring
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- early warning systems, timing, clinical deterioration, clinical decision-making, patient safety
- MeSH terms
- Clinical Deterioration, Early Warning Score, Anti-Bacterial Agents, Humans, Predictive Value of Tests, Time Factors, Sepsis
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