Predictive Monitoring - IMPact in Acute Care Cardiology Trial

(1) The number of hours free of acute clinical events within 21 day of admission. Hours of acute clinical events are defined as time when one or more of the following occur:

• An emergent ICU transfer (emergent defined as urgent, unplanned) and ICU stay
• Emergent intubation (emergent is defined by clinician's notes as a non-planned procedure)
• Cardiac arrest, if prior to ICU transfer or death
• Death

A maximum score will be 21 event-free days (504 hours). Patients who are discharged from the hospital prior to 21 days without an event will be counted as having 21 event-free days. Patients who die during the admission will be counted as having 0 event-free days. Patients will be censored (with no event observed) at the time of non-emergent ICU transfer, surgery transfer, or other transfer.

We will use a Kaplan Meier or Cox Proportional Hazard Curve to determine differences in response time between display and control.

• Time to the 1st order for transfusion of 3 units or more of blood ordered within 24 hours
• Time to first order for IV inotropes or pressors administered
• Time to first order for blood or urine culture obtained for suspicion of infection
• Time to first order for lactate drawn
• Time to first order for antibiotics given for suspicion of infection
• Time to first order for fluid resuscitation given for suspicion of shock
• Time to rapid response team (RRT or MET) call initiation.

A subgroup secondary outcome will be a Kaplan Meier or Cox Proportional Hazard curve showing post-ICU transfer, event-free survival, hours free of the following events:

• Time of emergent intubation post-ICU transfer (emergent is defined by clinician's notes as a non-planned procedure)
• Time of the 1st order post-ICU transfer for transfusion of 3 units or more of blood ordered within 24 hours
• Time of first order post-ICU transfer of IV inotropes or pressors
• Time of cardiac arrest post-ICU transfer
• Time of CHF escalation, defined by the time of first order for diuretic drip, time of first order for CVVHD, or time of dialysis initiation
• Time of death post-ICU transfer
• Discharge from the ICU without an event will count as "infinite" event-free survival.

Proportion of patients experiencing emergent ICU transfer (emergent defined as urgent, unplanned) at any point in the hospital stay after admission to the fourth floor:

Proportion of patients experiencing emergent intubation (emergent is defined by clinician's notes as a non-planned procedure) at any point in the hospital stay after admission to the fourth floor

Proportion of patients with 3 units or more of blood ordered in 24 hours at any point in the hospital stay after admission to the fourth floor

Proportion of patients receiving IV inotropes or pressors at any point in the hospital stay after admission to the fourth floor

Proportions of patients with shock requiring inotropes or pressors at any point in the hospital stay after admission to the fourth floor

Proportion of patients meeting Sepsis 2 criteria at any point in the hospital stay after admission to the fourth floor

Proportion of patients with septic shock requiring inotropes or pressors (defined by a combination of Outcome 8 and 9) at any point in the hospital stay after admission to the fourth floor

Proportion of patients experiencing cardiac arrest at any point in the hospital stay after admission to the fourth floor

Proportion of patients experiencing death at any point in the hospital stay after admission to the fourth floor

Proportion of patients receiving diuretic drip indicating Congestive Heart Failure escalation at any point in the hospital stay after admission to the fourth floor

Proportion patients receiving inotropes or pressors for refractory heart failure at any point in the hospital stay after admission to the fourth floor

Hospital length of stay

In patients who are never transferred to the ICU, the length of stay on the floor.

ICU length of stay

Readmission to hospital within 72 hours post-discharge

In patients who meet the Sepsis 2 criteria, the proportion of Shock, i.e. Hypotension requiring inotropes or pressors

In patients who meet the Sepsis 2 criteria, the proportion of death

Observed:Expected ratio

Number of days on IV antibiotics

Total duration of mechanical intubation (emergent and non-emergent)