OBJECTIVE: 

To evaluate the impact of health information technology (HIT) for early detection of patient deterioration on patient mortality and length of stay (LOS) in acute care hospital settings.

DATA SOURCES: 

We searched MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from 1990 to January 19, 2021.

STUDY SELECTION: 

We included studies that enrolled patients hospitalized on the floor, in the ICU, or admitted through the emergency department. Eligible studies compared HIT for early detection of patient deterioration with usual care and reported at least one end point of interest: hospital or ICU LOS or mortality at any time point.

DATA EXTRACTION: 

Study data were abstracted by two independent reviewers using a standardized data extraction form.

DATA SYNTHESIS: 

Random-effects meta-analysis was used to pool data. Among the 30 eligible studies, seven were randomized controlled trials (RCTs) and 23 were pre-post studies. Compared with usual care, HIT for early detection of patient deterioration was not associated with a reduction in hospital mortality or LOS in the meta-analyses of RCTs. In the meta-analyses of pre-post studies, HIT interventions demonstrated a significant association with improved hospital mortality for the entire study cohort (odds ratio, 0.78 [95% CI, 0.70–0.87]) and reduced hospital LOS overall.

CONCLUSIONS: 

HIT for early detection of patient deterioration in acute care settings was not significantly associated with improved mortality or LOS in the meta-analyses of RCTs. In the meta-analyses of pre-post studies, HIT was associated with improved hospital mortality and LOS; however, these results should be interpreted with caution. The differences in patient outcomes between the findings of the RCTs and pre-post studies may be secondary to confounding caused by unmeasured improvements in practice and workflow over time.

中文翻译：

---

健康信息技术对早期发现患者病情恶化对死亡率和住院时间的影响 急症护理环境：系统评价和荟萃分析*

客观的： 

评估健康信息技术 (HIT) 对急症护理医院环境中早期发现患者病情恶化对患者死亡率和住院时间 (LOS) 的影响。

数据源： 

我们检索了 1990 年至 2021 年 1 月 19 日期间的 MEDLINE 和 Epub Ahead of Print、In-Process & Other Non-Indexed Citations 以及 Daily、Embase、Cochrane Central Register of Controlled Trials、Cochrane Database of Systematic Reviews 和 Scopus。

研究选择： 

我们纳入了住院患者、重症监护病房或急诊科入院患者的研究。符合条件的研究将 HIT 与常规护理进行早期发现患者病情恶化的情况进行比较，并报告了至少一个感兴趣的终点：任何时间点的医院或 ICU LOS 或死亡率。

数据提取： 

研究数据由两名独立评审员使用标准化数据提取表格提取。

数据综合： 

使用随机效应荟萃分析来汇集数据。在 30 项符合条件的研究中，7 项是随机对照试验 (RCT)，23 项是事前研究。随机对照试验的荟萃分析显示，与常规护理相比，早期发现患者病情恶化的 HIT 与医院死亡率或住院时间的降低无关。在前后研究的荟萃分析中，HIT 干预措施表明，HIT 干预措施与整个研究队列的医院死亡率改善（比值比，0.78 [95% CI，0.70-0.87]）和整体医院住院时间降低显着相关。

结论： 

在随机对照试验的荟萃分析中，用于早期发现急性护理环境中患者病情恶化的 HIT 与死亡率或 LOS 改善没有显着相关。在前后研究的荟萃分析中，HIT 与改善医院死亡率和住院时间相关；然而，应谨慎解释这些结果。随机对照试验和事前研究结果之间的患者结果差异可能是由于实践和工作流程随着时间的推移而无法衡量的改进所造成的混杂因素。