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Despite low-level evidence, acutely ill patients are often continuously monitored. This creates high false alarm rates and alarm fatigue with unclear clinical effectiveness. We compare metrics, including alarm burden, area under the receiver operator characteristic curve (auROC), sensitivity, and specificity for threshold, score (i.e., National Early Warning Score [NEWS]), and machine learning (ML) alarms.We retrospectively annotated continuous biometric data for acutely ill patients receiving hospital care at home for clinical [...]

Deviation from evidence-based guidelines is common and associated with worse patient outcomes, especially in hectic emergency departments (EDs). Clinical decision support (CDS) systems can improve outcomes by promoting guideline adherence while allowing patient-specific adaptation. Implementation of a CDS system for pneumonia ("ePneumonia") in the ED has been associated with improved guideline adherence and reduced 30-day mortality. However, adoption of ePneumonia has been hindered by a suboptimal user interface (UI).This study [...]

Ambient listening tools utilize generative artificial intelligence (AI) to create clinical notes from real-time conversations between clinicians and patients during an encounter. One of the potential benefits of ambient listening tools is an improvement in reported patient experience.This study aimed to compare the patient experience of an outpatient visit during which an ambient listening tool is used with a standard visit and to quantify any perceived improvements in care.Patients completed [...]

Learning about critically ill children's outcomes after transfer to the pediatric intensive care unit (PICU) can help emergency department (ED) physicians improve future performance. However, there are no standard processes in place to systematically provide this information; thus, most ED physicians obtain inconsistent feedback.We aimed to determine the effect of delivering patient outcome feedback through the electronic health record (EHR) on the frequency of ED physicians' re-access of patients' EHRs [...]

This study aimed to compare two ambient AI documentation tools, Dragon Ambient eXperience (DAX) and Abridge in the emergency department (ED), assessing perceived effects on work burden, usability, documentation quality, satisfaction, and overall preference.We conducted a single-site, prospective crossover study in an ED over 6 weeks, from April to June 2025. Out of 20 faculty enrolled, 18 completed both phases. Participants used both ambient AI scribe tools in alternating 3-week [...]

Real-world data from vendor-aggregated health information exchanges represent a powerful resource for retrospective clinical research. Epic's Cosmos platform, a large-scale centralized data warehouse, enables querying deidentified electronic health record data.We describe the iterative development of a generalizable clinical informatics workflow for retrospective studies using Cosmos.We applied the Plan-Do-Study-Act cycle to iteratively refine a collaborative research process using Cosmo's SlicerDicer interface, focusing on setting, team, technical preparation, and workflow.We identified multiple [...]

The integration of large language models (LLMs) into clinical diagnostics presents significant challenges regarding their accuracy and reliability.This study aimed to evaluate the performance of DeepSeek R1, an open-source reasoning model, alongside two other LLMs, GPT-4.1 and Claude 3.5 Sonnet, across multiple-choice clinical cases.A dataset of complex medical cases representative of real-world clinical practice was selected.For efficiency, models were accessed via application programming interfaces (APIs) and assessed using standardized prompts [...]

Push notifications are a common method of clinical communication in inpatient settings, yet their volume and delivery patterns have not been described. Alert fatigue has been well-described in health care, and push notifications may be a new contributor.This study aimed to characterize the volume, type, and temporal distribution of push notifications received by hospitalists across distinct clinical roles in a large academic health system.We conducted a cross-sectional analysis of electronic [...]

Getting patients out of intensive care units (ICUs) is a major goal for acute care clinicians, as prolonged stays increase the risk of complications and strain critical resources such as staff, equipment, and beds. The ICU Liberation Bundle, or the ABCDEF (A-F) care bundle, is an evidence-based framework for improving outcomes in critically ill patients by addressing pain, sedation, delirium, mobility, and family engagement. However, variability in documentation and a [...]

Drive to Zero is a mobile health application (app) designed to identify and retain people with HIV (PWH) who have experienced challenges with achieving or maintaining viral suppression. The app targets PWH who have lacked documented HIV care in the past months and are experiencing medication adherence barriers. Features include an interactive chat for communicating with the study team and access to educational resources to support care engagement and health [...]