RT Journal Article SR Electronic T1 A scoping review of real-time automated clinical deterioration alerts and evidence of impacts on hospitalised patient outcomes JF BMJ Quality & Safety JO BMJ Qual Saf FD BMJ Publishing Group Ltd SP 725 OP 734 DO 10.1136/bmjqs-2021-014527 VO 31 IS 10 A1 Robin Blythe A1 Rex Parsons A1 Nicole M White A1 David Cook A1 Steven McPhail YR 2022 UL http://qualitysafety.bmj.com/content/31/10/725.abstract AB Background Hospital patients experiencing clinical deterioration are at greater risk of adverse events. Monitoring patients through early warning systems is widespread, despite limited published evidence that they improve patient outcomes. Current limitations including infrequent or incorrect risk calculations may be mitigated by integration into electronic medical records. Our objective was to examine the impact on patient outcomes of systems for detecting and responding to real-time, automated alerts for clinical deterioration.Methods This review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. We searched Medline, CINAHL and Embase for articles implementing real-time, automated deterioration alerts in hospitalised adults evaluating one or more patient outcomes including intensive care unit admission, length of stay, in-hospital cardiopulmonary arrest and in-hospital death.Results Of 639 studies identified, 18 were included in this review. Most studies did not report statistically significant associations between alert implementation and better patient outcomes. Four studies reported statistically significant improvements in two or more patient outcomes, and were the only studies to directly involve the patient’s clinician. However, only one of these four studies was robust to existing trends in patient outcomes. Of the six studies using robust study designs, one reported a statistically significant improvement in patient outcomes; the rest did not detect differences.Conclusions Most studies in this review did not detect improvements in patient outcomes following the implementation of real-time deterioration alerts. Future implementation studies should consider: directly involving the patient’s physician or a dedicated surveillance nurse in structured response protocols for deteriorating patients; the workflow of alert recipients; and incorporating model features into the decision process to improve clinical utility.Data sharing is not applicable as no data sets were generated and/or analysed for this study.