TY - JOUR
T1 - The Impact of Health Information Technology for Early Detection of Patient Deterioration on Mortality and Length of Stay in the Hospital Acute Care Setting
T2 - Systematic Review and Meta-Analysis∗
AU - Herasevich, Svetlana
AU - Lipatov, Kirill
AU - Pinevich, Yuliya
AU - Lindroth, Heidi
AU - Tekin, Aysun
AU - Herasevich, Vitaly
AU - Pickering, Brian W.
AU - Barwise, Amelia K.
N1 - Funding Information:
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.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - 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.
AB - 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.
KW - clinical decision support
KW - electronic health record
KW - electronic medical record
KW - hospital mortality
KW - informatics
KW - length of stay
KW - patient deterioration
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85134431162&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85134431162&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000005554
DO - 10.1097/CCM.0000000000005554
M3 - Review article
C2 - 35412476
AN - SCOPUS:85134431162
SN - 0090-3493
VL - 50
SP - 1198
EP - 1209
JO - Critical care medicine
JF - Critical care medicine
IS - 8
ER -