International Journal of Medical Informatics

Summary: The rapid deterioration observed in the condition of some hospitalized patients can be attributed to either disease progression or imperfect triage and level of care assignment after their admission. An early warning system (EWS) to identify patients at high risk of subsequent intrahospital death can be an effective tool for ensuring patient safety and quality of care and reducing avoidable harm and costs.

In this study, data collected from a system-wide electronic medical record (EMR) were exposed to multiple machine learning methods that were explored and compared. After constructing the model, we prospectively validated the algorithms as a real-time inpatient EWS for mortality. The EWS algorithm scored patients’ daily and long-term risk of inpatient mortality probability after admission and stratified them into distinct risk groups.

We demonstrated the capability of the newly-designed EWS to monitor and alert clinicians about patients at high risk of in-hospital death in real time, thereby providing opportunities for timely interventions. This real-time EWS is able to assist clinical decision making and enable more actionable and effective individualized care for patients’ better health outcomes in target medical facilities.