{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T11:57:28Z","timestamp":1765886248808,"version":"3.37.3"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,7,16]],"date-time":"2020-07-16T00:00:00Z","timestamp":1594857600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,7,16]],"date-time":"2020-07-16T00:00:00Z","timestamp":1594857600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["HICF-R9-524; WT-103703\/Z\/14\/Z"],"award-info":[{"award-number":["HICF-R9-524; WT-103703\/Z\/14\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Delay in identifying deterioration in hospitalised patients is associated with delayed admission to an intensive care unit (ICU) and poor outcomes. For the HAVEN project (HICF ref.: HICF-R9\u2013524), we have developed a mathematical model that identifies deterioration in hospitalised patients in real time and facilitates the intervention of an ICU outreach team. This paper describes the system that has been designed to implement the model. We have used innovative technologies such as Portable Format for Analytics (PFA) and Open Services Gateway initiative (OSGi) to define the predictive statistical model and implement the system respectively for greater configurability, reliability, and availability.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The HAVEN system has been deployed as part of a research project in the Oxford University Hospitals NHS Foundation Trust. The system has so far processed &gt;\u2009164,000 vital signs observations and\u2009&gt;\u200968,000 laboratory results for &gt;\u200912,500 patients and the algorithm generated score is being evaluated to review patients who are under consideration for transfer to ICU. No clinical decisions are being made based on output from the system. The HAVEN score has been computed using a PFA model for all these patients. The intent is that this score will be displayed on a graphical user interface for clinician review and response.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The system uses a configurable PFA model to compute the HAVEN score which makes the system easily upgradable in terms of enhancing systems\u2019 predictive capability. Further system enhancements are planned to handle new data sources and additional management screens.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12911-020-01176-0","type":"journal-article","created":{"date-parts":[[2020,7,16]],"date-time":"2020-07-16T09:02:46Z","timestamp":1594890166000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Implementing a system for the real-time risk assessment of patients considered for intensive care"],"prefix":"10.1186","volume":"20","author":[{"given":"Simarjot S.","family":"Dahella","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1559-4879","authenticated-orcid":false,"given":"James S.","family":"Briggs","sequence":"additional","affiliation":[]},{"given":"Paul","family":"Coombes","sequence":"additional","affiliation":[]},{"given":"Nazli","family":"Farajidavar","sequence":"additional","affiliation":[]},{"given":"Paul","family":"Meredith","sequence":"additional","affiliation":[]},{"given":"Timothy","family":"Bonnici","sequence":"additional","affiliation":[]},{"given":"Julie L.","family":"Darbyshire","sequence":"additional","affiliation":[]},{"given":"Peter J.","family":"Watkinson","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2020,7,16]]},"reference":[{"key":"1176_CR1","volume-title":"Hospital Adult Critical Care Activity","author":"NHS Digital","year":"2017","unstructured":"NHS Digital. Hospital Adult Critical Care Activity. 2017."},{"issue":"3","key":"1176_CR2","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1002\/jhm.964","volume":"7","author":"V Liu","year":"2012","unstructured":"Liu V, Kipnis P, Rizk NW, Escobar GJ. Adverse outcomes associated with delayed intensive care unit transfers in an integrated healthcare system. J Hosp Med. 2012;7(3):224\u201330.","journal-title":"J Hosp Med"},{"key":"1176_CR3","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1109\/SIEDS.2015.7116976","volume-title":"2015 Systems and Information Engineering Design Symposium, SIEDS 2015","author":"M Craft","year":"2015","unstructured":"Craft M, Dobrenz B, Dornbush E, Hunter M, Morris J, Stone M, et al. An assessment of visualization tools for patient monitoring and medical decision making. In: 2015 Systems and Information Engineering Design Symposium, SIEDS 2015; 2015. p. 212\u20137."},{"key":"1176_CR4","volume-title":"Recognising and responding appropriately to early signs of deterioration in hospitalised patients","author":"National Patient Safety Agency","year":"2007","unstructured":"National Patient Safety Agency. Recognising and responding appropriately to early signs of deterioration in hospitalised patients. 2007."},{"issue":"4","key":"1176_CR5","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1097\/CCM.0000000000000038","volume":"42","author":"MM Churpek","year":"2014","unstructured":"Churpek MM, Yuen TC, Park SY, Gibbons R, Edelson DP. Using electronic health record data to develop and validate a prediction model for adverse outcomes in the wards*. Crit Care Med. 2014;42(4):841\u20138.","journal-title":"Crit Care Med"},{"issue":"8","key":"1176_CR6","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1016\/j.resuscitation.2011.03.006","volume":"82","author":"L Tarassenko","year":"2011","unstructured":"Tarassenko L, Clifton DA, Pinsky MR, Hravnak MT, Woods JR, Watkinson PJ. Centile-based early warning scores derived from statistical distributions of vital signs. Resuscitation. 2011;82(8):1013\u20138.","journal-title":"Resuscitation"},{"issue":"4","key":"1176_CR7","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.resuscitation.2012.12.016","volume":"84","author":"GB Smith","year":"2013","unstructured":"Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013;84(4):465\u201370.","journal-title":"Resuscitation"},{"issue":"2","key":"1176_CR8","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/j.resuscitation.2007.12.004","volume":"77","author":"GB Smith","year":"2008","unstructured":"Smith GB, Prytherch DR, Schmidt PE, Featherstone PI. Review and performance evaluation of aggregate weighted \u201ctrack and trigger\u201d systems. Resuscitation. 2008;77(2):170\u20139.","journal-title":"Resuscitation"},{"issue":"3","key":"1176_CR9","doi-asserted-by":"publisher","first-page":"R132","DOI":"10.1186\/cc13947","volume":"18","author":"S Yu","year":"2014","unstructured":"Yu S, Leung S, Heo M, Soto GJ, Shah RT, Gunda S, et al. Comparison of risk prediction scoring systems for ward patients: a retrospective nested case-control study. Crit Care. 2014;18(3):R132.","journal-title":"Crit Care"},{"issue":"4","key":"1176_CR10","doi-asserted-by":"publisher","first-page":"424.e7","DOI":"10.1016\/j.jcrc.2012.01.003","volume":"27","author":"J Ludikhuize","year":"2012","unstructured":"Ludikhuize J, Smorenburg SM, de Rooij SE, de Jonge E. Identification of deteriorating patients on general wards; measurement of vital parameters and potential effectiveness of the Modified Early Warning Score. J Crit Care. 2012;27(4):424.e7\u2013424.e13.","journal-title":"J Crit Care"},{"issue":"2","key":"1176_CR11","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1002\/jhm.812","volume":"6","author":"SR Bapoje","year":"2011","unstructured":"Bapoje SR, Gaudiani JL, Narayanan V, Albert RK. Unplanned transfers to a medical intensive care unit: causes and relationship to preventable errors in care. J Hosp Med. 2011;6(2):68\u201372.","journal-title":"J Hosp Med"},{"key":"1176_CR12","doi-asserted-by":"publisher","first-page":"S40","DOI":"10.1016\/S0140-6736(15)60355-5","volume":"385","author":"S Harris","year":"2015","unstructured":"Harris S, Singer M, Rowan K, Sanderson C. Delay to admission to critical care and mortality among deteriorating ward patients in UK hospitals: a multicentre, prospective, observational cohort study. Lancet. 2015;385:S40.","journal-title":"Lancet"},{"issue":"6","key":"1176_CR13","doi-asserted-by":"publisher","first-page":"1000","DOI":"10.1007\/s00134-011-2156-x","volume":"37","author":"G J\u00e4derling","year":"2011","unstructured":"J\u00e4derling G, Calzavacca P, Bell M, Martling CR, Jones D, Bellomo R, et al. The deteriorating ward patient: a Swedish-Australian comparison. Intensive Care Med. 2011;37(6):1000\u20135.","journal-title":"Intensive Care Med"},{"issue":"10","key":"1176_CR14","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1097\/00003246-198510000-00009","volume":"13","author":"WA Knaus","year":"1985","unstructured":"Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818\u201329 Available from: http:\/\/europepmc.org\/abstract\/MED\/3928249.","journal-title":"Crit Care Med"},{"key":"1176_CR15","unstructured":"Java Software | Oracle United Kingdom. Available from: https:\/\/www.oracle.com\/uk\/java\/. Accessed 10 Feb 2020."},{"key":"1176_CR16","unstructured":"MySQL. Available from: https:\/\/www.mysql.com\/. Accessed 10 Feb 2020."},{"key":"1176_CR17","unstructured":"OSGi\u2122 Alliance \u2013 The Dynamic Module System for Java. Available from: https:\/\/www.osgi.org\/. Accessed 10 Feb 2020."},{"key":"1176_CR18","unstructured":"PFA. Portable Format for Analytics. Available from: http:\/\/dmg.org\/pfa\/. Accessed 10 Feb 2020."},{"key":"1176_CR19","unstructured":"React \u2013 A JavaScript library for building user interfaces. Available from: https:\/\/reactjs.org\/. Accessed 10 Feb 2020."},{"key":"1176_CR20","unstructured":"Benefits of Using OSGi \u2013 OSGi\u2122 Alliance. Available from: https:\/\/www.osgi.org\/developer\/benefits-of-using-osgi\/. Accessed 10 Feb 2020."},{"key":"1176_CR21","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s12911-015-0186-y","volume":"15","author":"D Wong","year":"2015","unstructured":"Wong D, Bonnici T, Knight J, Morgan L, Coombes P, Watkinson P. SEND: a system for electronic notification and documentation of vital sign observations. BMC Med Inform Decis Mak. 2015;15:68.","journal-title":"BMC Med Inform Decis Mak"},{"key":"1176_CR22","unstructured":"GitHub - modelop\/hadrian: Implementations of the Portable Format for Analytics (PFA). Available from: https:\/\/github.com\/modelop\/hadrian. Accessed 10 Feb 2020."},{"key":"1176_CR23","unstructured":"Spring Boot. Available from: https:\/\/spring.io\/projects\/spring-boot. Accessed 10 Feb 2020."},{"key":"1176_CR24","unstructured":"What is REST \u2013 Learn to create timeless REST APIs. Available from: https:\/\/restfulapi.net\/. Accessed 10 Feb 2020."},{"key":"1176_CR25","unstructured":"JSON. Available from: https:\/\/www.json.org\/json-en.html. Accessed 10 Feb 2020."},{"key":"1176_CR26","unstructured":"npm | build amazing things. Available from: https:\/\/www.npmjs.com\/. Accessed 10 Feb 2020."},{"issue":"11","key":"1176_CR27","doi-asserted-by":"publisher","first-page":"1618","DOI":"10.1080\/001401398186108","volume":"41","author":"LG Militello","year":"1998","unstructured":"Militello LG, Hutton RJB. Applied cognitive task analysis (ACTA): a practitioner\u2019s toolkit for understanding cognitive task demands. Ergonomics. 1998;41(11):1618\u201341.","journal-title":"Ergonomics"},{"key":"1176_CR28","unstructured":"Card Sorting | The Encyclopedia of Human-Computer Interaction, 2nd Ed. Available from: https:\/\/www.interaction-design.org\/literature\/book\/the-encyclopedia-of-human-computer-interaction-2nd-ed\/card-sorting. Accessed 10 Feb 2020."},{"key":"1176_CR29","unstructured":"Improvement Hub \u00bb Improvement Leaders\u2019 Guide \u2013 Process Mapping, Analysis and Redesign \u2013 General Improvement Skills. Available from: https:\/\/www.england.nhs.uk\/improvement-hub\/publication\/improvement-leaders-guide-process-mapping-analysis-and-redesign-general-improvement-skills\/. Accessed 10 Feb 2020."},{"issue":"1","key":"1176_CR30","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/1472-6963-10-7","volume":"10","author":"L Colligan","year":"2010","unstructured":"Colligan L, Anderson JE, Potts HW, Berman J. Does the process map influence the outcome of quality improvement work? A comparison of a sequential flow diagram and a hierarchical task analysis diagram. BMC Health Serv Res. 2010;10(1):7. [cited 2020 Feb 10]. https:\/\/doi.org\/10.1186\/1472-6963-10-7.","journal-title":"BMC Health Serv Res"}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-020-01176-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12911-020-01176-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-020-01176-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T23:35:12Z","timestamp":1626392112000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-020-01176-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,16]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1176"],"URL":"https:\/\/doi.org\/10.1186\/s12911-020-01176-0","relation":{},"ISSN":["1472-6947"],"issn-type":[{"type":"electronic","value":"1472-6947"}],"subject":[],"published":{"date-parts":[[2020,7,16]]},"assertion":[{"value":"5 March 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 July 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 July 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"REC (Research Ethics Committee) approval 16\/SC\/0264 and CAG (Confidentiality Advisory Group) approval 16\/SC\/0066.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"PW co-developed the System for Electronic Notification and Documentation (SEND), for which Sensyne Health has purchased a sole licence. The company has a research agreement with the University of Oxford and royalty agreements with Oxford University Hospitals NHS Trust and the University of Oxford. PW\u00a0was the Chief Medical Officer for Sensyne Health\u00a0and holds shares in the company.\u00a0His department has received funding from Sensyne Health. PW and TB receive royalties on sales of SEND from Sensyne Health.\u00a0The other authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"161"}}