Barts Health NHS Trust -...
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Barts Health NHS TrustPreventing ED re-attendances
by leveraging narrative data
Charles Gutteridge MDBhavi Trivedi MD
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Founded 1123Turnover £1.2B
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Ris
k s
trat
ific
atio
n
Co
-ord
inat
ed c
are
Reduce
emergency
attendances
Reduce
emergency
admissions
Improve
outcomesQAdmission® algorithm
(Consent)
(Enrol)
East London Integrated Care Programme
High
Moderate
Low
Very low
Very high
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Target population for community-based intervention
510
3,0247,074
≥ 1 ED attendance
≥ 4 ED attendances
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Reasons for attending the ED
Pain
Shortness of breath
Generally Unwell
Fall
Chest Pain
Confusion
Chest infection
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Current algorithm• Dependent on structured data in primary care record
• Focuses on medical problems
• Social history and functional status not included
Hypothesis • Point of care narrative information = most accurate
• May indicate factors increasing risk of attendance
ED clerkings• Barts Health ED: 7 years of electronic
documents
NLP
& ML
The answer is in the data…?
•Clinithink CLiX ENRICH
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Preliminary findings
• The method allows for encoding of free text narrative to identify features
• Further validation is underway
• The features can predict risk of multiple attendances to the ED with an accuracy of 83%
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Next steps
• Apply methodology to real-time clinical situations to reduce frequency of attendance and improve outcomes
• Deeper examination of selected features
• Combine knowledge of presenting complaint with feature analysis