Development of a novel computer aided risk score to predict the risk of death in hospital for acutely ill medical patients using their first blood test results and vital signs after admission.

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... 7 CARS demonstrated better discrimination and calibration than blood tests and NEWS separately. 5 Despite the widespread use of risk scores to enhance decision-making in healthcare, as identified by Braband et al, 2 there is little or no documentary evidence of the involvement of healthcare practitioners and service users or carers (SU/Cs) in the design, development and implementation of this type of risk score. Our research responds to this gap. ...
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Objectives: The Computer Aided Risk Score (CARS) estimates the risk of death following emergency admission to medical wards using routinely collected vital signs and blood test data. Our aim was to elicit the views of health care practitioners (staff) and Service Users and Carers (SU/C) on i) the potential value, unintended consequences and concerns associated with CARS and practitioner views on ii) the issues to consider before embedding CARS into routine practice. Setting: This study was conducted in two NHS Hospital Trusts in the North of England. Both had inhouse IT development teams, mature IT infrastructure with electronic National Early Warning Score (NEWS) and were capable of integrating NEWS with blood test results. The study focused on emergency medical and elderly admissions units. There were 60 and 39 acute medical/elderly admissions beds at the two NHS hospital Trusts. Participants: We conducted eight focus groups with 45 health care practitioners and two with 11 service users and carers (SU/Cs) in two NHS acute hospitals. Results: Staff and SU/Cs recognised the potential of CARS but were clear the score should not replace or undermine clinical judgments. Staff recognised CARS could enhance clinical decision making/judgments and aid communication with patients. They wanted to understand the components of CARS and be reassured about its accuracy but were concerned about the impact on intensive care and blood tests. Conclusion: Risk scores are widely used in healthcare, but their development and implementation does not usually involve input from practitioners and SU/Cs. We contributed to the development of CARS by eliciting views of staff and SU/Cs who provided important, often complex, insights to support the development and implementation of CARS to ensure successful implementation in routine clinical practice.
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