Christopher A Longhurst

University of California, San Diego | UCSD · Department of Pediatrics

Importance Since work-hour restrictions were instituted in 2003, sustainably complying with duty-hour regulations remains a challenge for general surgery residency programs across the nation. Objective To determine whether industry-based process improvement techniques could be leveraged to increase compliance with work-hour restrictions within a g...

Background SARS-CoV-2 antibody levels have been proposed as a correlate of protection (CoP) from infection. Yet, large-scale prospective studies of cost-effective scalable antibody measures as predictors of infection under real-world conditions are limited. We examined whether antibody levels measured using high-throughput variant-specific SARS-CoV...

Importance Despite various attempts to improve patient-clinician communication, there has been limited head-to-head comparison of these efforts. Objective To assess whether clinician coaching (mobile application or in-person) is more effective than reminder posters in examination rooms and whether mobile app use is noninferior to in-person coachin...

Many patients infected with the SARS-CoV-2 virus (COVID-19) continue to experience symptoms for weeks to years as sequelae of the initial infection, referred to as “Long COVID”. Although many studies have described the incidence and symptomatology of Long COVID, there are little data reporting the potential burden of Long COVID on surgical departme...

Background Wearing a mask was a crucial component in slowing the COVID-19 pandemic. However, little is known about the intersectionality between mask usage, risk perception, and infection. The purpose of this study was to investigate whether risk perceptions and masking behaviors are associated with contracting SARS-CoV-2 and how contracting SARS-C...

This Viewpoint highlights the potential for artificial intelligence (AI) health care tools to introduce unintended patient harm; calls for an efficient, rigorous approach to AI testing and certification that is the shared responsibility of developers and users; and makes recommendations to inform such an approach.

Introduction Addressing physician burnout is critical for healthcare systems. As electronic health record (EHR) workload and teamwork have been identified as major contributing factors to physician well‐being, we aimed to mitigate burnout through EHR‐based interventions and a compassion team practice (CTP), targeting EHR workload and team cohesion....

BACKGROUND Sepsis is a major cause of morbidity and mortality for which early intervention improves patient outcomes. However, many patients experience delays in appropriate diagnosis and treatment. Predictive modeling and artificial intelligence may aid in early recognition of sepsis but there remains a considerable disconnect between the developm...

Background Coaching has been demonstrated to be an effective physician wellness intervention. However, this evidence-based intervention has not yet been widely adopted in the physician community. Documentation and implementation research of interventions to address physician burnout in real world settings is much needed. Objective Assess the impac...

Objective Integrating clinical research into routine clinical care workflows within electronic health record systems (EHRs) can be challenging, expensive, and labor-intensive. This case study presents a large-scale clinical research project conducted entirely within a commercial EHR during the COVID-19 pandemic. Case Report The UCSD and UCSDH COVI...

OBJECTIVES Healthcare ransomware cyberattacks have been associated with major regional hospital disruptions, but data reporting patient-oriented outcomes in critical conditions such as cardiac arrest (CA) are limited. This study examined the CA incidence and outcomes of untargeted hospitals adjacent to a ransomware-infected healthcare delivery orga...

Background Electronic health record (EHR)-based patient messages can contribute to burnout. Messages with a negative tone are particularly challenging to address. In this perspective, we describe our initial evaluation of large language model (LLM)-generated responses to negative EHR patient messages and contend that using LLMs to generate initial...

Introduction Effective communication in the operating room (OR) is crucial. Addressing a colleague by their name is respectful, humanising, entrusting and associated with improved clinical outcomes. We aimed to enhance team communication in the perioperative environment by offering personalised surgical caps labelled with name and provider role to...

Importance Timely tests are warranted to assess the association between generative artificial intelligence (GenAI) use and physicians’ work efforts. Objective To investigate the association between GenAI-drafted replies for patient messages and physician time spent on answering messages and the length of replies. Design, Setting, and Participants...

Background Effective primary care necessitates follow-up actions by the patient beyond the visit. Prior research suggests room for improvement in patient adherence. Objective This study sought to understand patients’ views on their primary care visits, the plans generated therein, and their self-reported adherence after 3 months. Methods As part...

Objectives Effective communication amongst healthcare workers simultaneously promotes optimal patient outcomes when present and is deleterious to outcomes when absent. The advent of electronic health record (EHR)-embedded secure instantaneous messaging systems has provided a new conduit for provider communication. This manuscript describes the expe...

Sepsis remains a major cause of mortality and morbidity worldwide. Algorithms that assist with the early recognition of sepsis may improve outcomes, but relatively few studies have examined their impact on real-world patient outcomes. Our objective was to assess the impact of a deep-learning model (COMPOSER) for the early prediction of sepsis on pa...

Background Infection prevention (IP) measures are designed to mitigate the transmission of pathogens in healthcare. Using large-scale viral genomic and social network analyses, we determined if IP measures used during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic were adequate in protecting healthcare workers (HCWs) and...

Importance Procedural proficiency is a core competency for graduate medical education; however, procedural reporting often relies on manual workflows that are duplicative and generate data whose validity and accuracy are difficult to assess. Failure to accurately gather these data can impede learner progression, delay procedures, and negatively imp...

BACKGROUND Sepsis is a major cause of morbidity and mortality for which early intervention improves patient outcomes. However, many patients experience delays in appropriate diagnosis and treatment. Predictive modeling and machine learning may aid in early recognition of sepsis but there remains a considerable disconnect between the development of...

Objectives Effective communication between surgeons and anesthesiologists is critical for high-quality, safe, and efficient perioperative patient care. Despite widespread implementation of surgical safety checklists and time-outs, ineffective team communication remains a leading cause of patient safety events in the operating room. To promote effec...

IMPORTANCE Despite the broad adoption and optimization of electronic health record (EHR) systems across the continuum of care, serious usability and safety problems persist. OBJECTIVE To assess whether EHR safety performance is associated with EHR frontline user experience in a national sample of hospitals. DESIGN, SETTING, AND PARTICIPANTS This...

Background: Coaching has been demonstrated to be an effective physician wellness intervention. However, this evidence-based intervention has not yet been widely adopted in the community. Documentation and implementation research of interventions to address physician burnout in real world settings is much needed. Objective: Assess the impact of a vi...

Purpose Digital methods to augment traditional contact tracing approaches were developed and deployed globally during the COVID-19 pandemic. These “Exposure Notification (EN)” systems present new opportunities to support public health interventions. To date, there have been attempts to model the impact of such systems, yet no reports have explored...

BACKGROUND Effective primary care necessitates follow-up actions by the patient beyond the visit. Prior research suggests room for improvement in patient adherence. OBJECTIVE This study sought to understand patients’ views on their primary care visits, the plans generated therein, and their self-reported adherence after 3 months. METHODS As part...

Objective: Physicians of all specialties experienced unprecedented stressors during the COVID-19 pandemic, exacerbating preexisting burnout. We examine burnout's association with perceived and actionable electronic health record (EHR) workload factors and personal, professional, and organizational characteristics with the goal of identifying lever...

Importance: Cyberattacks on health care delivery organizations are increasing in frequency and sophistication. Ransomware infections have been associated with significant operational disruption, but data describing regional associations of these cyberattacks with neighboring hospitals have not been previously reported, to our knowledge. Objective...

Importance: The rapid expansion of virtual health care has caused a surge in patient messages concomitant with more work and burnout among health care professionals. Artificial intelligence (AI) assistants could potentially aid in creating answers to patient questions by drafting responses that could be reviewed by clinicians. Objective: To eval...

Background: Implementing an electronic health record (EHR) is one of the most disruptive operational tasks a health system can undergo. Despite anecdotal reports of adverse events around the time of EHR implementations, there is limited corroborating research, particularly in pediatrics. We utilized data from Solutions for Patient Safety (SPS), a...

Objective: Occupational health (OH) documentation has traditionally been separate from health system electronic health records (EHRs), but this can create patient safety and care continuity challenges. Herein we describe outcomes and challenges of such integration including how one health system managed compliance with laws, regulations and ethica...

This paper reviews the current state of patient safety and the application of artificial intelligence (AI) techniques to patient safety. This paper defines patient safety broadly, not just inpatient care but across the continuum of care, including diagnostic errors, misdiagnosis, adverse events, injuries, and measurement issues. It outlines the maj...

Long COVID is a chronic condition characterized by symptoms such as fatigue, dyspnea, and cognitive impairment that persist or relapse months after an acute infection with the SARS-CoV-2 virus. Many distinct symptoms have been attributed to Long COVID; however, little is known about the potential clustering of these symptoms and risk factors that m...

Importance Physician burnout is an ongoing epidemic; electronic health record (EHR) use has been associated with burnout, and the burden of EHR inbasket messages has grown in the context of the COVID-19 pandemic. Understanding how EHR inbasket messages are associated with physician burnout may uncover new insights for intervention strategies. Obje...

Objectives: Toward common methods for system monitoring and evaluation, we proposed a key performance indicator framework and discussed lessons learned while implementing a statewide exposure notification (EN) system in California during the COVID-19 epidemic. Materials and methods: California deployed the Google Apple Exposure Notification fram...

Multiple independent frameworks to support continuous improvement have been proposed to guide healthcare organizations. Two of the most visible are High‐reliability Health care, (Chassin et al., 2013) which is emphasized by The Joint Commission, and Learning Health Systems, (Institute of Medicine, 2011) highlighted by the National Academy of Medici...

BACKGROUND Recent advancements in machine learning (ML) and the proliferation of healthcare data have led to widespread excitement about using these technologies to improve care. Predictive analytic models in domains such as sepsis, acute kidney injury, respiratory failure, and general deterioration have been proposed to improve the timely administ...

Background Sepsis costs and incidence vary dramatically across diagnostic categories, warranting a customized approach for implementing predictive models. Objective The aim of this study was to optimize the parameters of a sepsis prediction model within distinct patient groups to minimize the excess cost of sepsis care and analyze the potential ef...

The true incidence and comprehensive characteristics of Long COVID and its accompanying symptoms are currently unknown. This is the first population-based outreach study of Long COVID symptoms in patients within an entire health system, conducted to determine operational needs of the health system to care for patients with Long COVID.

Objective To optimize the parameters of a sepsis prediction model within distinct patient groups to minimize the excess cost of sepsis care and analyze the potential effect of factors contributing to end-user response to sepsis alerts on overall model utility. Materials and Methods We calculated the excess costs of sepsis by comparing patients wit...

As SARS-CoV-2 continues to spread and evolve, detecting emerging variants early is critical for public health interventions. Inferring lineage prevalence by clinical testing is infeasible at scale, especially in areas with limited resources, participation, or testing/sequencing capacity, which can also introduce biases1–3. SARS-CoV-2 RNA concentrat...

Background and objectives: Telemedicine bridges the gap between care needs and provider availability. The value of telemedicine can be eclipsed by long wait times, especially if patients are stuck in virtual waiting rooms. UCSD Tele-Untethered allows patients to join visits without waiting in virtual waiting rooms. Tele-Untethered uses a text-to-v...

Value-based, outcome-oriented care supported with innovative technology is the future of surgery. We established a novel fellowship in Perioperative Administration, Quality, and Informatics. The aim is to equip future surgeon scholars with the requisite knowledge base and skillset to serve as institutional leaders capable of transforming surgical h...

The growing availability of multi‐scale biomedical data sources that can be used to enable research and improve healthcare delivery has brought about what can be described as a healthcare “data age.” This new era is defined by the explosive growth in bio‐molecular, clinical, and population‐level data that can be readily accessed by researchers, cli...

This cross-sectional study assesses the incidence of new-onset type 1 diabetes among US children during the COVID-19 pandemic.

Objective The COVID-19 pandemic changed clinician electronic health record (EHR) work in a multitude of ways. To evaluate how, we measure ambulatory clinician EHR use in the United States throughout the COVID-19 pandemic. Materials and Methods We use EHR meta-data from ambulatory care clinicians in 366 health systems using the Epic EHR system in t...

Introduction Digital exposure notification (EN) approaches may offer considerable advantages over traditional contact tracing in speed, scale, efficacy, and confidentiality in pandemic control. We applied the science of learning health systems to test the effect of framing and digital means, email vs Short Message Service (SMS), on EN adoption amon...

BACKGROUND: Patient-physician communication during clinical encounters is essential to ensure quality of care. Many studies have attempted to improve patient-physician communication. Incorporating patient priorities into agenda setting and medical decision-making are fundamental to patient-centered communication. Efficient and scalable approaches a...

Objective: The year 2020 was predominated by the coronavirus disease 2019 (COVID-19) pandemic. The objective of this article is to review the areas in which clinical information systems (CIS) can be and have been utilized to support and enhance the response of healthcare systems to pandemics, focusing on COVID-19. Methods: PubMed/MEDLINE, Google Sc...

Background Statins have anti-inflammatory and immunomodulatory effects that may reduce the severity of coronavirus disease 2019 (COVID-19), in which organ dysfunction is mediated by severe inflammation. Large studies with diverse populations evaluating statin use and outcomes in COVID-19 are lacking. Methods and results We used data from 10,541 pa...

This cross-sectional study examines differences in electronic health record use across adult and pediatric primary care specialties.

BACKGROUND Patient-physician communication during clinical encounters is essential to quality of care. Numerous efforts have been attempted to improve patient-physician communication. Incorporating patient priorities into agenda setting and medical decision making are fundamental to patient-centered communication. Efficient and scalable approaches...

Background: Patient-physician communication during clinical encounters is essential to ensure quality of care. Many studies have attempted to improve patient-physician communication. Incorporating patient priorities into agenda setting and medical decision-making are fundamental to patient-centered communication. Efficient and scalable approaches...

Unstructured: With the emergence of the COVID-19 pandemic and shortage of adequate Personal Protective Equipment (PPE), hospitals implemented inpatient telemedicine measures to ensure operational readiness and a safe working environment for clinicians. The utility and sustainability of inpatient telemedicine initiatives need to be evaluated as the...

In 2017, 43.9% of US physicians reported symptoms of burnout. Poor electronic health record (EHR) usability and time-consuming data entry contribute to burnout. However, less is known about how modifiable dimensions of EHR use relate to burnout and how these associations vary by medical specialty. Using the KLAS Arch Collaborative’s large-scale nat...

UNSTRUCTURED With the emergence of the COVID-19 pandemic and shortage of adequate personal protective equipment (PPE), hospitals implemented inpatient telemedicine measures to ensure operational readiness and a safe working environment for clinicians. The utility and sustainability of inpatient telemedicine initiatives need to be evaluated as the n...

Objective Clinical decision support (CDS) can contribute to quality and safety. Prior work has shown that errors in CDS systems are common and can lead to unintended consequences. Many CDS systems use Boolean logic, which can be difficult for CDS analysts to specify accurately. We set out to determine the prevalence of certain types of Boolean logi...

Large-scale wastewater surveillance has the ability to greatly augment the tracking of infection dynamics especially in communities where the prevalence rates far exceed the testing capacity. However, current methods for viral detection in wastewater are severely lacking in terms of scaling up for high throughput. In the present study, we employed...

Objective The University of California at San Diego (UCSD) Health system’s institution-wide response to the COVID-19 pandemic was founded on rapid development of in-house testing capacity, optimization of PPE usage, expansion of ICU capacity, development of analytic dashboards for monitoring of institutional status, and implementation of an OR tria...

Objective To detail the implementation, benefits and challenges of onboarding campus-based health services onto a health system’s electronic health record. Participants UC San Diego Student Health and Well-Being offers medical services to over 39,000 students. UC San Diego Health is an academic medical center. Methods 20 workstreams and 9 electro...

Objective The coronavirus disease 2019 pandemic has inspired new innovations in diagnosing, treating, and dispositioning patients during high census conditions with constrained resources. Our objective is to describe first experiences of physician interaction with a novel artificial intelligence (AI) algorithm designed to enhance physician abilitie...

Background: The authors draw upon their experience with a successful, enterprise-level, telemedicine program implementation to present a "How To" paradigm for other academic health centers that wish to rapidly deploy such a program in the setting of the COVID-19 pandemic. The advent of social distancing as essential for decreasing viral transmissio...

UNSTRUCTURED The telehealth revolution has been heralded for its potential to improve health care access and improve the efficiency of health care delivery. However, virtual patient care can bring unintended consequences that eclipse the benefits including potentially limiting the patient-provider relationship, the quality of the examination, the e...

Unstructured: The telehealth revolution in response to COVID-19 increased essential health care access during an unprecedented public health crisis. However, virtual patient care can also limit the patient-provider relationship, the quality of the examination, the efficiency of healthcare delivery, and the overall quality of care. Facing the most...