JMIR Publications

ABSTRACT

Background:

Early warning tools identify patients at risk of deterioration in hospitals. Electronic medical records in hospitals offer real-time data, and the opportunity to automate early warning tools and provide real-time, dynamic risk estimates.

Objective:

This review describes published studies on the development, validation and implementation of tools for prediction of patient deterioration in hospital general wards.

Methods:

An electronic database search of peer-reviewed journal papers 2008-2020 identified studies reporting the use of tools and algorithms for predicting patient deterioration - defined by unplanned transfer to intensive care unit (ICU), cardiac arrest, or death. Studies conducted solely in ICUs, emergency departments or on single diagnosis patient groups were excluded.

Results:

Forty-five publications, eligible for inclusion, were heterogeneous in design, setting and outcome measures. Most papers were retrospective studies utilizing cohort data to develop, validate or statistically evaluate prediction tools. Tools consisted of early warning, screening or scoring systems based on physiologic data, as well as more complex algorithms developed to better represent real-time, deal with complexities of longitudinal data and warn of deterioration risk earlier. Only a few studies detailed the results of implementation of the deterioration warning tools.

Conclusions:

Despite relative progress on the development of algorithms to predict patient deterioration, the literature has not shown that the deployment or implementation of such algorithms is reproducibly associated with improvement of patient outcomes. Further work is needed to realise the potential of automated predictions and updating dynamic risk estimates as part of an operational early warning system for inpatient deterioration.