Protocol describing a systematic review and mixed methods consensus process to define the deteriorated ward patient

Area of Science:

• Clinical Informatics
• Patient Outcomes Research
• Healthcare Quality Improvement

Background:

• A significant number of hospitalized patients deteriorate, requiring advanced care.
• Current outcome measures for patient deterioration are subjective and variable.
• This variability hinders the development of accurate electronic medical record (EMR)-linked predictive tools.

Purpose of the Study:

• To develop a novel, objective outcome measure for clinically deteriorated hospitalized adult patients.
• To address limitations in current proxy outcomes used in observational studies.
• To facilitate the creation of more accurate digital tools for predicting clinical deterioration.

Main Methods:

• Systematic literature review to identify existing definitions of clinical deterioration.
• International modified Delphi study to shortlist candidate definitions.
• Nominal group technique (NGT) with diverse stakeholders to reach a consensus definition.
• Ensuring the final definition is readily extractable from EMR data.

Main Results:

• (Study protocol stage) A multi-stage mixed-methods approach is detailed.
• The protocol aims to generate a consensus definition for patient deterioration.
• The proposed definition will be designed for EMR data extraction.

Conclusions:

• A standardized, EMR-extractable definition is needed to improve clinical deterioration prediction.
• This protocol outlines a robust method for developing such a definition.
• The findings will support the advancement of digital health tools in patient monitoring.