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Communicating Narrative Concerns Entered by RNs Early Warning System (CONCERN EWS) is a machine-learning predictive model that leverages nursing surveillance documentation patterns to predict deterioration risks for hospitalized patients. In a retrospective cohort study of 1,013 hospital encounters with unanticipated ICU transfers from a multi-site pragmatic randomized controlled trial, we assessed the influence of CONCERN EWS on in-hospital mortality and length of stay following unanticipated ICU transfers. Chi-square tests, t-tests, multivariate logistic regression, and generalized linear models were used. Our findings showed that patients who had unanticipated ICU transfers from acute care units with CONCERN EWS had a lower in-hospital mortality rate and a shorter average hospital stay than those transferred from units receiving usual care. These results suggest that CONCERN EWS enhances shared situational awareness for care teams, improves communication, and effectively facilitates timely interventions, thereby streamlining care processes and improving patient outcomes.
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J Clin Med
July 2025
Division of Critical Care, Pulmonary and Sleep Medicine, University of Texas Health Science Center, Houston, TX 77030, USA.
The management of difficult airways is one of the most critical and challenging aspects of emergency and ICU care. Despite technological advances, unanticipated airway difficulty can result in serious complications, including hypoxia, brain injury, and death. This comprehensive narrative review aims to consolidate current algorithms and evidence-based strategies to guide clinicians in the assessment and management of difficult airways.
View Article and Find Full Text PDFBMC Anesthesiol
July 2025
Department of Anesthesia and Perioperative Care, University of California, San Francisco, USA.
Background: Unplanned postoperative intensive care unit admissions (UIAs) are rare events that cause significant challenges to perioperative workflow. We describe the development of a machine-learning derived model to predict UIAs using only widely used preoperative variables.
Methods: This was a 3-year retrospective review of all adult surgeries under the General, Vascular, and Thoracic surgical services with anticipated length of greater than 180 minutes at a single institution.
World J Crit Care Med
June 2025
Department of Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States.
Background: The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit (ICU) is an unanticipated event with possible life-threatening consequences. Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality. Two different types of unplanned ICU admissions include upgrades (patients admitted to the floor then moved to the ICU) and bounce backs (patients admitted to the ICU, discharged to the floor, and then readmitted to the ICU).
View Article and Find Full Text PDFAMIA Annu Symp Proc
May 2025
Columbia University, Department of Biomedical Informatics, New York, NY.
Communicating Narrative Concerns Entered by RNs Early Warning System (CONCERN EWS) is a machine-learning predictive model that leverages nursing surveillance documentation patterns to predict deterioration risks for hospitalized patients. In a retrospective cohort study of 1,013 hospital encounters with unanticipated ICU transfers from a multi-site pragmatic randomized controlled trial, we assessed the influence of CONCERN EWS on in-hospital mortality and length of stay following unanticipated ICU transfers. Chi-square tests, t-tests, multivariate logistic regression, and generalized linear models were used.
View Article and Find Full Text PDFNat Med
June 2025
University of Pennsylvania, Philadelphia, PA, USA.
The COmmunicating Narrative Concerns Entered by RNs (CONCERN) early warning system (EWS) uses real-time nursing surveillance documentation patterns in its machine learning algorithm to identify deterioration risk. We conducted a 1-year, multisite, pragmatic trial with cluster-randomization of 74 clinical units (37 intervention; 37 usual care) across 2 health systems. Eligible adult hospital encounters were included.
View Article and Find Full Text PDF