We previously developed a personalized AI model to predict surgical transfusion risk. Here we simulated using it for preop T&S decisions at 45 US hospitals. Our model (S-PATH) did better than the standard of care approach (MSBOS). We also measured performance using a clinically meaningful benchmark, the number of T&S ordered. S-PATH needed ~ 1/3 fewer while maintaining 96% sensitivity for finding patients who need blood. Importantly, we used S-PATH out of the box. No retraining or fine tuning on individual hospitals. Nonetheless, it still performed well. This kind of robustness is rare among AI models, and suggests S-PATH could be immediately useful for many hospital systems.
EHR-integrated secure messaging is increasingly used for clinical communication, yet relatively little is known about its impact on clinician workflow. In this study, we measured the relationship between secure messaging use, clinician workload, and cognitive burden. We found that high secure messaging use was associated with increased EHR time and attention switching, suggesting that secure messaging may negatively impact clinician work.
Presurgical blood orders are important for patient safety during surgery, but excess orders can be costly to patients and the healthcare system. We assessed clinician perceptions on the presurgical blood ordering process and perceived barriers to reliable decision-making, including lack of information on surgical transfusion risk, lack of experience in ordering clinicians, and poor communication between stakeholders.
Many studies have suggested that higher cognitive burden is associated with increased burnout and risk for errors. However, it has been challenging to measure the cognitive load associated with clinician work within the electronic health record. Here we developed a novel scalable method to measure cognitive load using audit log data and demonstrate its validity.
EHR-integrated secure messaging is increasingly used for clinical communication, yet relatively little is known about how it affects how clinicians communicate with each other. In this study, we evaluated the relationship between secure messaging and telephone use among resident physicians. We found that more secure messaging use was associated with more telephone use, which goes against the hypothesis that secure chat might replace telephone use.
Preparation for transfusion is important, but excessive preparation is common, costly, and contributes to blood waste. This tool helps doctors identify patients at risk for transfusion so they can get the care they need. We evaluated the tool's performance at 414 NSQIP-contributing hospitals, and found that it showed promising generalizability and could potentially be used across a diverse range of hospitals to assist with perioperative planning.
EHR-integrated secure messaging is increasingly used for clinical communication, yet relatively little is known about how it is used and who its primary users are. In this study, we characterized secure messaging users and their messaging behaviors within a large health system. We found that secure messaging was widely used by a diverse range of healthcare professionals, with many users interacting with over 20 messages per day. The short message response times and high messaging volume observed highlight the interruptive nature of secure messaging, raising questions about its potentially harmful effects on clinician workflow, cognition, and errors.
We compared EHR-based workload with reimbursement in anesthesiology and found that payments for anesthesia services are likely poorly calibrated with clinical workload, largely by not recognizing the physical and cognitive effort of caring for the sickest patients. This likely penalizes academic and safety net hospitals the most. Our method for measuring clinical workload from EHR audit log data could be used to measure the time and intensity of clinical work more objectively to better inform healthcare policy.
Surgical transfusion has an outsized impact on hospital-based transfusion services, leading to blood product waste and unnecessary costs. In this paper, we describe the design and implementation of a streamlined reliable process for perioperative blood ordering and delivery to reduce red cell waste.
Audit logs have great potential for studying the EHR-based workflows and work habits of physicians and other healthcare professionals. However, one major barrier is the granularity of the data, which makes identification of discrete clinical tasks difficult. In this paper, we describe a novel unsupervised approach using the comparison and visualization of EHR action embeddings to learn context and structure from raw audit log activities, which can be useful for task identification and annotation.