Abstract:Objective: To determine whether clinicians will use machine learned clinical order recommender systems for electronic order entry for simulated inpatient cases, and whether such recommendations impact the clinical appropriateness of the orders being placed.
Materials and Methods: 43 physicians used a clinical order entry interface for five simulated medical cases, with each physician-case randomized whether to have access to a previously-developed clinical order recommendation system. A panel of clinicians sco… Show more
“… 14 , 15 , 16 , 17 Predictive models using statistical inference and machine learning are finding opportunities to enhance diagnosis. 16 , 17 , 18 , 19 There is prior research identifying risk factors for STEMI as a disease. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 However, developing a predictive model to enhance timely diagnosis requires an understanding of risk factors for STEMI diagnostic delay.…”
Background
ST‐segment elevation myocardial infarction (STEMI) guidelines recommend screening arriving emergency department (ED) patients for an early ECG in those with symptoms concerning for myocardial ischemia. Process measures target median door‐to‐ECG (D2E) time of 10 minutes.
Methods and Results
This 3‐year descriptive retrospective cohort study, including 676 ED‐diagnosed patients with STEMI from 10 geographically diverse facilities across the United States, examines an alternative approach to quantifying performance: proportion of patients meeting the goal of D2E≤10 minutes. We also identified characteristics associated with D2E>10 minutes and estimated the proportion of patients with screening ECG occurring during intake, triage, and main ED care periods. We found overall median D2E was 7 minutes (IQR:4–16; range: 0–1407 minutes; range of ED medians: 5–11 minutes). Proportion of patients with D2E>10 minutes was 37.9% (ED range: 21.5%–57.1%). Patients with D2E>10 minutes, compared to those with D2E≤10 minutes, were more likely female (32.8% versus 22.6%,
P
=0.005), Black (23.4% versus 12.4%,
P
=0.005), non‐English speaking (24.6% versus 19.5%,
P
=0.032), diabetic (40.2% versus 30.2%,
P
=0.010), and less frequently reported chest pain (63.3% versus 87.4%,
P
<0.001). ECGs were performed during ED intake in 62.1% of visits, ED triage in 25.3%, and main ED care in 12.6%.
Conclusions
Examining D2E>10 minutes can identify opportunities to improve care for more ED patients with STEMI. Our findings suggest sex, race, language, and diabetes are associated with STEMI diagnostic delays. Moving the acquisition of ECGs completed during triage to intake could achieve the D2E≤10 minutes goal for 87.4% of ED patients with STEMI. Sophisticated screening, accounting for differential risk and diversity in STEMI presentations, may further improve timely detection.
“… 14 , 15 , 16 , 17 Predictive models using statistical inference and machine learning are finding opportunities to enhance diagnosis. 16 , 17 , 18 , 19 There is prior research identifying risk factors for STEMI as a disease. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 However, developing a predictive model to enhance timely diagnosis requires an understanding of risk factors for STEMI diagnostic delay.…”
Background
ST‐segment elevation myocardial infarction (STEMI) guidelines recommend screening arriving emergency department (ED) patients for an early ECG in those with symptoms concerning for myocardial ischemia. Process measures target median door‐to‐ECG (D2E) time of 10 minutes.
Methods and Results
This 3‐year descriptive retrospective cohort study, including 676 ED‐diagnosed patients with STEMI from 10 geographically diverse facilities across the United States, examines an alternative approach to quantifying performance: proportion of patients meeting the goal of D2E≤10 minutes. We also identified characteristics associated with D2E>10 minutes and estimated the proportion of patients with screening ECG occurring during intake, triage, and main ED care periods. We found overall median D2E was 7 minutes (IQR:4–16; range: 0–1407 minutes; range of ED medians: 5–11 minutes). Proportion of patients with D2E>10 minutes was 37.9% (ED range: 21.5%–57.1%). Patients with D2E>10 minutes, compared to those with D2E≤10 minutes, were more likely female (32.8% versus 22.6%,
P
=0.005), Black (23.4% versus 12.4%,
P
=0.005), non‐English speaking (24.6% versus 19.5%,
P
=0.032), diabetic (40.2% versus 30.2%,
P
=0.010), and less frequently reported chest pain (63.3% versus 87.4%,
P
<0.001). ECGs were performed during ED intake in 62.1% of visits, ED triage in 25.3%, and main ED care in 12.6%.
Conclusions
Examining D2E>10 minutes can identify opportunities to improve care for more ED patients with STEMI. Our findings suggest sex, race, language, and diabetes are associated with STEMI diagnostic delays. Moving the acquisition of ECGs completed during triage to intake could achieve the D2E≤10 minutes goal for 87.4% of ED patients with STEMI. Sophisticated screening, accounting for differential risk and diversity in STEMI presentations, may further improve timely detection.
“…Beyond validation of clinically meaningful endpoints, demonstrating clinical usability involves study of the AI model in a real-world setting, where it interfaces with clinical practitioners and patients. Evaluation of effects of the model on time task, user satisfaction, and acceptance of AI recommendations should be performed (Kumar et al, 2020). A mechanism of feedback should be integrated into the design of the platform to identify weak points and opportunities for improved interface (Cutillo et al, 2020).…”
Section: Challenges For Clinical Translation: Beyond Performance Validationmentioning
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