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Application of Medical Information Systems for the detection of high risk patients: rapid care alerts. Pilot study of
L Socías Crespí1, G Heras La Calle, V M Estrada Rodríguez
1Servicio de Medicina Intensiva, Hospital Son Llàtzer, Palma de Mallorca, España. lsocias@hsll.es
Objective:
To describe the implementation of a Medical Information System (MIS) in the Critical Care Departament (CCD).
Design:
A prospective observational cohort study was carried out.
Setting:
Clinical and Surgical wards in Son Llàtzer Hospital.
Patients:
Patients with criteria of rapid care alert (RCA) without treatment, cardiac arrest (CA), and unexpected ward deaths (UWD), during 2010.
Main Variables:
Age, sex, nursing shift, nursing alert, vital signs, unplanned admission to intensive care, CA, UWD and death.
Results:
The MIS detected 9647 episodes with RCA signs in 4020 patients (26.4 episodes/day). A total of 8547 episodes were reviewed. Sixty-five patients required rapid response by the intensive care staff; 61.5% were detected in the afternoon shift (15:00 a 22:00), and 61.5% were admitted to the CCD. Diminished consciousness (DC) and respiratory failure were the most frequent problems. The sepsis rate was 23%. We reviewed 45 CA and 35 UWD. Of the total cases of CA, 33 patients died (73.3%) and 66.7% had criteria of untreated RCA. Monitoring (P<.05) and rhythms amenable to defibrillation (P<.002) were associated to survival. As regards the UWD, 75% had criteria of untreated RCA, and 40.6% presented diminished consciousness. In the last 6 months there was a significant reduction in UWD (P=.01)
Conclusions:
The MIS could be a complimentary tool in the activity of the CCD to improve the prognosis of hospitalized patients.
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