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Early prediction of patient outcomes is key to unlocking the potential for targeted preventive care. This protocol describes a practical workflow for developing deep learning risk models for early prediction of various clinical and operational outcomes using structured electronic health record (EHR) data, discussing the prediction of acute kidney injury (AKI) as an exemplar. The protocol consists of 34 steps grouped into the following stages: formal problem definition, data pre-processing, architecture selection, calibration and uncertainty estimation, generalisability evaluation. Additionally, we demonstrate the application of this protocol to three other endpoints -mortality, length of stay and 30-day hospital readmission -for both continuous predictions (e.g. triggered every 6h) and static predictions (e.g. triggered at 24h post admission). The performance on these additional endpoints exceeded most comparable literature benchmarks. This protocol is accompanied by an open-source codebase that illustrates key considerations for EHR modeling and may be customised to alternate data formats and prediction tasks.

Raising awareness of the problems patients may experience following discharge from day surgery may encourage a more pro-active attitude towards planning discharge services by a combined approach from day surgery nurses and community (district) nurses.

Abstract:Background: The amount and complexity of (ambulatory) day surgery is rapidly expanding internationally. Nurses have a responsibility to provide quality care for day surgery patients. To do this they must understand all aspects of the patient experience. There is dearth of research into day surgery using a sociological frame of reference. Objective: The study investigated patients' experiences of day surgery using a sociological frame of reference. Design: A qualitative study using the Grounded Theory approach was used. Setting: The study was based in two day surgery units in two urban public hospitals in the United Kingdom. Participants: 145 patients aged 18-70 years and 100 carers were purposely selected from the orthopaedic, ear nose and throat and general surgical lists. They were all English speaking and were of varied socio-economic background. Methods: The data was collected from [2004][2005][2006]. Semi-structured interviews were conducted on 3 occasions: before surgery, 48 hours following surgery and one month following discharge. Permission was received from the Local Research Ethics Committee. Analysis of the data involved line-by line analysis, compilation of key words and phrases (codes) and constant comparison of the codes until categories emerged. Findings: Patients liked day surgery and placed it within the wider societal context of efficiency and speed. Time was a major issue for them. They wished surgery, like all other aspects of their life to be a speedy process. They likened it to a McDonald's experience with its emphasis on speed, predictability and control. Conclusion: This study throws new light on patient experiences and offers an understanding of day surgery against a western culture which emphasises the importance of speed and efficiency. It is a popular choice for patients but at times it can be seen to be a mechanistic way of providing care. The implications for nurses to provide education and information to add to the quality of the patient experience are discussed.

Title: Therapeutic Relationships in Day Surgery: A Grounded Theory study. Aim: The aim of the study was to explore patients' experiences of day surgery.Background: Therapeutic relationships are considered to be a core dimension of nursing care. However in modern healthcare with short hospital stays the formation of these relationships may be impeded. A major theme to emerge from this study was the development of therapeutic relationships in the day surgery setting.