Abstract
BackgroundThe development and validation of automated electronic medical record (EMR) search strategies are important for establishing the timing of mechanical ventilation initiation in the intensive care unit (ICU).Thus, we sought to develop and validate an automated EMR search algorithm (strategy) for time zero, the moment of mechanical ventilation initiation in the critically ill patient.MethodsThe EMR search algorithm was developed on the basis of several mechanical ventilation parameters, with the final parameter being positive end-expiratory pressure (PEEP), and was applied to a comprehensive institutional EMR database. The search algorithm was derived from a secondary retrospective analysis of a subset of 450 patients from a cohort of 2,684 patients admitted to a medical ICU and a surgical ICU from January 1, 2010, through December 31, 2011. It was then validated in an independent subset of 450 patients from the same period. The overall percent of agreement between our search algorithm and a comprehensive manual medical record review in the derivation and validation subsets, using peak inspiratory pressure (PIP) as the reference standard, was compared to assess timing of mechanical ventilation initiation.ResultsIn the derivation subset, the automated electronic search strategy achieved an 87% (κ = 0.87) perfect agreement, with 94% agreement to within one minute. In validating this search algorithm, perfect agreement was found in 92% (κ = 0.92) of patients, with 99% agreement occurring within one minute.ConclusionsThe use of an electronic search strategy resulted in highly accurate extraction of mechanical ventilation initiation in the ICU. The search algorithm of mechanical ventilation initiation is highly efficient and reliable and can facilitate both clinical research and patient care management in a timely manner.
Highlights
The development and validation of automated electronic medical record (EMR) search strategies are important for establishing the timing of mechanical ventilation initiation in the intensive care unit (ICU)
The present article is a subsequent report to an initial publication describing the programmatic processes used for developing and validating an automated electronic medical record (EMR) search strategy for identifying emergent endotracheal intubations in a medical intensive care unit (ICU) or surgical ICU [1]
The ability to accurately identify the temporal occurrence of a major clinical event from the EMR allows, in combination with other clinically relevant parameters, the in-depth retrospective analysis of factors which may help in the early identification of the deteriorating patient and the possibility to prevent adverse clinical events in the future
Summary
The development and validation of automated electronic medical record (EMR) search strategies are important for establishing the timing of mechanical ventilation initiation in the intensive care unit (ICU). The ability to accurately identify the temporal occurrence of a major clinical event (such as emergent endotracheal intubation) from the EMR allows, in combination with other clinically relevant parameters (e.g., heart rate, blood pressure, cardiac index, etc.), the in-depth retrospective analysis of factors which may help in the early identification of the deteriorating patient and the possibility to prevent adverse clinical events (such as post-intubation hemodynamic instability) in the future. Both these steps are needed before retrospectively evaluating possible risk factors associated with hemodynamic disturbances during emergent endotracheal intubations in critically ill patients
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