Early detection and treatment of acute illness in medical patients with novel software: a prospective quality improvement initiative

Objective An ageing population and rising healthcare costs place healthcare systems at risk of failure. Our goal was to develop a technology that would identify illness early, initiate action and therein improve patient care, outcomes and save healthcare resources. Design This was a prospective interventional quality improvement study. Setting A 40 bed medical floor in a 300 bed Canadian tertiary care regional referral hospital. Participants General ward patients randomly assigned to control or treatment groups. There was no cross-over or loss to follow-up. Intervention We designed an algorithm and software programme capable of detecting the sentinel change in a deteriorating patient's clinical condition and once detected direct early investigation and care. Study duration was 1 year. Main outcome measures Primary outcome was patient transfer from the general medical ward to the intensive care unit (ICU). The secondary outcome was the time needed to (1) order investigations (2) contact senior medical staff and (3) senior medical staff intervention. Results We identified a decrease in the transfer of patients from the medical ward to the ICU. Over the course of the study including 273 patients (110 in the control group and 163 in the treatment group), transfers dropped from 14 to 3 with a relative risk reduction of 85.54% (95% CI 84.96 to 86.1), a number needed to treat of 9.19 (95% CI 9.01 to 9.36) and a absolute risk reduction of 10.89% (95% CI 10.7 to 11.1). We also found a statistically significant reduction in the time required to order investigations (p=0.049), contact senior medical staff (p=0.040) and senior medical staff intervention (p=0.045). Conclusion A novel algorithm and software in the hands of nursing staff identified acute illness with adequate sensitivity and specificity to dramatically reduce ICU transfers and time to clinical intervention on a medical ward.