Development, Implementation and Validation of an Early Warning System for Clinical Deterioration in Hospitalised Patients

Phase 1. Derivation of the predictive model Data from patients admitted to the participating centres during 2017 will be extracted from the OBI electronic medical record and the laboratory data management system. The data analyst contracted in this project, together with clinical collaborators, from the health management unit and the research unit, will be responsible for cleaning and cleaning the data and for the generation and internal validation of the predictive model.

Phase 2: Implementation in the electronic medical record: Once the model and the risk scale have been generated, it will be implemented as an alarm system in Osabide Global in the participating centres. To this end, an action guide will be created by the HGU's UGS, which, once validated, will then be exported to the other two centres. The system will operate on the basis of the RIC elements associated with vital signs, and will guide professionals through the process, so that the physician will be shown the analytical data that have been shown to be necessary to calculate the risk, or in the event that the patient has not been asked for that specific laboratory test, recommendations for extraction. Once the system has all the data, a warning will pop up on the screen with the results of the risk scale and the mild-moderate-severe risk category and a report with recommendations for action.Recommendations based on the ViEWS scale, from the physician informing the nurse in charge at the start of continuous monitoring and visit in less than 15 minutes by the responsible attending physician who will also inform the ICU physician to the transfer of the patient to a unit where he/she will be monitored and acted upon, are given in annex 1. The alarm system will be presented in the HGU by the clinical collaborators, GSU and data analyst. The data analyst will be, together with the co-researchers, the person in charge of generating the alarm system, of participating in the meetings in which it is presented in the centres and subsequently, will carry out a constant exploration of the use and adherence of the risk scale, will collect doubts and problems that may arise from the implementation of the system, and will also be responsible for the implementation of the risk scale.

Phase 3: External validation of the predictive model. Comparison of clinical outcomes: The predictive model will be validated once 100 events per centre have occurred (hopefully once about 8000 patients have been admitted). During this time, data will be collected during and after implementation in order to compare clinical deteriorations observed before and after implementation. The data analyst will be extracting the information, sorting and cleaning it in order to be able to carry out the corresponding statistical analyses later on.

STATISTICAL ANALSIS

The data processing procedure of the present project will be established following the following steps, divided into two sections: