1. The Health Outcome: Shorter duration of mechanical ventilation in the ICU.

Extubation from mechanical ventilation is one of the most important, carefully considered decisions a clinician in the intensive care setting must make each day in the ICU.  It carries significant morbidity, cost and even mortality.

Medical research usually focuses on effective approaches to prevent or treat a specific disease or condition, but what if instead, we could study the effectiveness of an intervention for maintaining health?  We propose the Healthy Start study, a randomized controlled trial examining whether flagging newborns with an excess rate of  weight loss impacts health outcomes in the first month after birth. By conducting this first Learning Healthcare System trial in the well newborn population, we hope to study the preservation of health from the time of a healthy birth onwards.

De-escalating routine care: Using Machine Learning to Automatically Reduce Vital Sign Checks in Stable Patients

Background 

ULTRASOUND-FIRST CLINICAL DECISION SUPPORT FOR SUSPECTED NEPHROLITHIASI

1. Health Outcome: Reduction in Radiation Exposure in ED Patients with Suspected Nephrolithiasis

The proposed health outcome is the reduction in unnecessary radiation exposure from computed tomography (CT) use in emergency department (ED) patients with suspected nephrolithiasis. Due to its high accuracy and 24/7 availability for detecting ureteral stones, CT is the most commonly used imaging test for patients presenting to the ED with acute flank pain or abdominal pain who are suspected to suffer from nephrolithiasis.¹ Recent national surveys and multicenter studies have estimated CT use to range from 71-83% of patients with a diagnosis of renal colic or kidney stone. Only 10% of these patients, however, require inpatient admission and urologic intervention.^2,3 A recent randomized trial found that outcomes are no better in patients who are evaluated with CT than those who are evaluated with ultrasound, suggesting that we can reduce CT use with no untoward impact on patient health outcomes.⁴ Thus, we intend to create an intervention based on this trial to decrease radiation dose in patients with suspected nephrolithiasis at low risk for a serious outcome, such as a complicated stone (uro-sepsis, renal deterioration, uncontrolled symptoms) and important alternative diagnoses (appendicitis, diverticulitis). Radiation exposure will be measured as mean effective dose.

1. THE HEALTH OUTCOME:  Documented Advance Care Planning (ACP) in the EHR.