Verbesserte Patientensicherheit durch „clinical decision support systems“ in der Labormedizin

Eckelt, Felix; Remmler, Johannes; Kister, Thea Sophie; Wernsdorfer, Mark; Richter, H; Federbusch, Martin; Adler, Martin W.; Kehrer, Alexander; Voigt, Markus; Cundius, Carina; Telle, Jörg; Thiéry, Jean‐Claude; Kaiser, Thorsten

doi:10.1007/s00108-020-00775-3

Cited by 12 publications

(6 citation statements)

References 26 publications

(11 reference statements)

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“…Both groups undergo the AMPEL analysis but only the results for the intervention group are presented in the AMPEL column of the SAP R/3 terminal (for an example, see Figure 3). Preliminary results show that the time to control (TTC) is considerably lower for patients of the test group ( [16] and unpublished data). Based on AMPEL's transparency of actions, its deterministic algorithms, and the randomized controlled experiment setting, there is solid reason to assume this is due to AMPEL's notifications.…”

Section: Quantifiable Benefitmentioning

confidence: 93%

See 1 more Smart Citation

The Clinical Decision Support System AMPEL for Laboratory Diagnostics: Implementation and Technical Evaluation

Costa¹,

Wernsdorfer²,

Kehrer³

et al. 2021

JMIR Med Inform

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Background Laboratory results are of central importance for clinical decision making. The time span between availability and review of results by clinicians is crucial to patient care. Clinical decision support systems (CDSS) are computational tools that can identify critical values automatically and help decrease treatment delay. Objective With this work, we aimed to implement and evaluate a CDSS that supports health care professionals and improves patient safety. In addition to our experiences, we also describe its main components in a general manner to make it applicable to a wide range of medical institutions and to empower colleagues to implement a similar system in their facilities. Methods Technical requirements must be taken into account before implementing a CDSS that performs laboratory diagnostics (labCDSS). These can be planned within the functional components of a reactive software agent, a computational framework for such a CDSS. Results We present AMPEL (Analysis and Reporting System for the Improvement of Patient Safety through Real-Time Integration of Laboratory Findings), a labCDSS that notifies health care professionals if a life-threatening medical condition is detected. We developed and implemented AMPEL at a university hospital and regional hospitals in Germany (University of Leipzig Medical Center and the Muldental Clinics in Grimma and Wurzen). It currently runs 5 different algorithms in parallel: hypokalemia, hypercalcemia, hyponatremia, hyperlactatemia, and acute kidney injury. Conclusions AMPEL enables continuous surveillance of patients. The system is constantly being evaluated and extended and has the capacity for many more algorithms. We hope to encourage colleagues from other institutions to design and implement similar CDSS using the theory, specifications, and experiences described in this work.

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Section: Quantifiable Benefitmentioning

confidence: 93%

“…AMPEL is essentially a notification system [16]. When the value of a laboratory parameter falls outside of predefined reference limits, a quick medical reaction is of paramount importance (eg., K + ≤2.0 mmol/L, defining severe hypokalemia).…”

Section: Objectivesmentioning

confidence: 99%

The Clinical Decision Support System AMPEL for Laboratory Diagnostics: Implementation and Technical Evaluation

Costa¹,

Wernsdorfer²,

Kehrer³

et al. 2021

JMIR Med Inform

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“…Mittlerweile gibt es einige Vorschläge, die Anämiediagnostik und -therapie per CDSS zu unterstützen 41 , 42 , 43 , 44 , 45 , 46 . Eine CDSS-Umsetzung aus der Labormedizin heraus hat im deutschsprachigen Raum das AMPEL-System (Analyse- und Meldesystem zur Verbesserung der Patientensicherheit durch Echtzeitintegration von Laborbefunden) der Universitätsmedizin Leipzig erreicht ( ), mithilfe dessen wir für Applikationen in der Laboratoriumsmedizin bereits erste Effekte und Potenziale für die Verbesserung der Patientensicherheit zeigen können 47 , 48 , 49 . Relevante Faktoren im Zuge der Behandlung einer Anämie (Hb- und physiologische Transfusionstrigger, Kontrolle, sowie weitere klinischen Parameter) können zukünftig in das AMPEL CDSS implementiert und damit für klinisch tätige Kollegen, aber auch Transfusionsmediziner sichtbarer gemacht werden.…”

Section: Diskussionunclassified

Novelle QLL 2020 – welche Auswirkungen haben die neu empfohlenen Hämoglobin-Transfusionstrigger auf die klinische Versorgung?

Kotzerke

Costa

Voigt

et al. 2022

Transfusionsmedizin

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ZusammenfassungIn der Gesamtnovelle der Querschnittsleitlinie (QLL) Hämotherapie der Bundesärztekammer (BÄK) 2020 wurde der Hämoglobin-Transfusionstrigger (Hb-Transfusionstrigger) bei akutem Blutverlust ohne zusätzliche Risikofaktoren aufgrund einer Neubewertung der internationalen Evidenz von 3,7 mmol/l (6 g/dl) auf 4,3 mmol/l (7 g/dl) angepasst. Ziel der vorliegenden Studie ist die retrospektive Analyse des Transfusionsverhaltens von EK bezüglich der Maßgaben der QLL. Zu diesem Zweck analysierten wir individuelle Prä- und Posttransfusions-Hb-Werte von Erythrozytenkonzentraten (EK), die im 4. Quartal 2019 (4946 EKs, 129 560 Hb-Werte) und 2020 (5502 EKs, 134 404 Hb-Werte) am Universitätsklinikum Leipzig (UKL) transfundiert wurden. Der mediane Hb-Wert vor der Transfusion betrug 4,3 mmol/l (7 g/dl) (680 medizinische Fälle, die 2724 EK in 1801 Transfusionen im Jahr 2019 erhielten). Von allen Transfusionen im Jahr 2019 zeigten 899 (49,9%) Transfusionen Hb-Werte < 4,3 mmol/l (7 g/dl) vor der Transfusion, während 152 (8,4%) Hb-Werte < 3,7 mmol/l (6 g/dl) aufwiesen. 2020 wurden jeweils vergleichbare Ergebnisse ermittelt. Wir zeigen, dass der mediane Hb-Anstieg nach der Transfusion eines EK 0,6 mmol/l (1 g/dl) betrug. 34,7% aller Transfusionen erreichten den erwarteten Anstieg von 0,6 mmol/l (1 g/dl) pro EK. Der absolute Anstieg nahm bei Transfusionen mit mehreren EK im Vergleich zu Transfusionen mit einem EK nicht linear zu. Der Grad der Hb-Erhöhung korrelierte invers mit dem Hb-Wert vor Transfusion. Der Hb-Wert nach der Transfusion wurde bei 96,3% der Fälle innerhalb von 24 Stunden nach Hämotherapie kontrolliert. Zusammenfassend spiegelt das Transfusionsverhalten generell die Empfehlungen der Leitlinie. Um ein optimiertes, individualisiertes und dennoch restriktives Transfusionsverhalten bei EK zu erreichen, schlagen wir die Implementierung eines klinischen Entscheidungsunterstützungssystems (CDSS) bei Verschreibung jeder einzelnen EK-Transfusion vor, welches Ärzte bei der Einhaltung der Transfusionsleitlinie unterstützt und über Abweichungen informiert.

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“…Clinical and laboratory data was automatically collected from electronic patient records within the clinic information system using the frameworks of the AMPEL system [11] (www.ampel. care), a CDSS, to monitor laboratory results.…”

Section: Acquisition Of Datamentioning

confidence: 99%

Acute kidney injury and its progression in hospitalized patients—Results from a retrospective multicentre cohort study with a digital decision support system

et al. 2021

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In this retrospective multicentric cohort study, we evaluate the potential benefits of a clinical decision support system (CDSS) for the automated detection of Acute kidney injury (AKI). A total of 80,389 cases, hospitalized from 2017 to 2019 at a tertiary care hospital (University of Leipzig Medical Center (ULMC)) and two primary care hospitals (Muldentalkliniken (MTL)) in Germany, were enrolled. AKI was defined and staged according to the Kidney disease: improving global outcomes (KDIGO) guidelines. Clinical and laboratory data was automatically collected from electronic patient records using the frameworks of the CDSS. In our cohort, we found an overall AKI incidence proportion of 12.1%. We identified 6,393/1,703/1,604 cases as AKI stage 1/2/3 (8.0%/2.1%/2.0%, respectively). Administrative coding with N17 (ICD-10-GM) was missing in 55.8% of all AKI cases with the potential for additional diagnosis related groups (DRG) reimbursement of 1,204,200 € in our study. AKI was associated with higher hospital mortality, increased length of hospitalisation and more frequent need of renal replacement therapy. A total of 19.1% of AKI cases (n = 1,848) showed progression to higher AKI stages (progressive AKI) during hospitalization. These cases presented with considerably longer hospitalization, higher rates of renal replacement therapy and increased mortality (p<0.001, respectively). Furthermore, progressive AKI was significantly associated with sepsis, shock, liver cirrhosis, myocardial infarction, and cardiac insufficiency. AKI, and especially its progression during hospitalization, is strongly associated with adverse outcomes. Our automated CDSS enables timely detection and bears potential to improve AKI outcomes, notably in cases of progressive AKI.

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Verbesserte Patientensicherheit durch „clinical decision support systems“ in der Labormedizin

Cited by 12 publications

References 26 publications

The Clinical Decision Support System AMPEL for Laboratory Diagnostics: Implementation and Technical Evaluation

The Clinical Decision Support System AMPEL for Laboratory Diagnostics: Implementation and Technical Evaluation

Novelle QLL 2020 – welche Auswirkungen haben die neu empfohlenen Hämoglobin-Transfusionstrigger auf die klinische Versorgung?

Acute kidney injury and its progression in hospitalized patients—Results from a retrospective multicentre cohort study with a digital decision support system

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