How Clinical Status Sorting Reduces Hospital Incidents

Assessing the Impact of Clinical Status Sorting on Reducing Hospital Incidents in Dialysis Sorting and highlighting clinical conditions of dialysis patients in the DIASYS list functions as a "risk stratification and safety dashboard" tool. According to international evidence, this approach can reduce hospital incidents such as falls, pressure ulcers, infections, and medication errors—provided it's paired with standardized intervention bundles. Evidence from dashboards integrated with electronic health records and risk assessment tools shows that when patient risk is transparently visible and sortable for the clinical team, rates of certain adverse events (such as thromboembolism and pressure ulcers) decrease significantly, and completion of preventive interventions increases.

Theoretical Framework: From Patient Lists to Risk Stratification

In modern patient safety models, "early identification of high-risk patients" is the cornerstone of incident prevention. This is typically accomplished using structured EHR data and risk assessment tools. Quality and safety dashboards connected to electronic health records use scores like Morse, Braden, VTE risk, and clinical data to categorize patients into low, medium, and high-risk levels, showing the clinical team which patients require immediate intervention. Sorting clinical conditions in DIASYS by "level of caution" fits precisely within this framework, transforming the patient list into a risk-focused dashboard.

International Evidence on EHR Dashboards and Incident Reduction

A study on an integrated safety and quality dashboard in EHR (Epic) demonstrated that displaying patient risk across nine safety categories (including falls, pressure ulcers, VTE, catheters, etc.) and color-coding patients from low to high risk improved identification of high-risk patients and guided team interventions. It was recognized as an effective tool for reducing incident risk. Another study found that implementing a VTE risk stratification tool in EHR with automatic prophylaxis recommendations was associated with a significant reduction in thromboembolic events following surgical procedures. Risk management guidelines and reports also emphasize that using EHR data for risk stratification and population dashboards leads to more timely interventions and reduces preventable emergency visits and hospitalizations.

Evidence on Risk Assessment Tools (Braden, Morse, etc.)

The Braden tool and other scales are among the most common instruments for assessing pressure ulcer risk, with numerous studies demonstrating their effectiveness in predicting risk and designing care plans. While systematic reviews on the direct effect of "merely using scales" on reducing pressure ulcer prevalence have found limited conclusive evidence, they emphasize that when scales are combined with educational programs and care bundles, systematic planning and prevention are facilitated.

Recent research on the accuracy of Braden subscales and implementation of automated fall and pressure ulcer assessment systems shows that integrating these scores with EHR and automatic alerts can improve identification of high-risk patients and increase use of preventive interventions.

Incident Status in Hemodialysis and the Importance of Risk Tools

Studies in hemodialysis units have shown that the prevalence of adverse events (including blood flow errors, vascular problems, infections, hypotension, falls, and medication issues) is very high, with a large portion being potentially preventable. Analytical reviews of hemodialysis safety state that focusing solely on dialysis equipment is insufficient—attention must be paid to recognizing and managing infectious, medication, fall, electrolyte, and organizational risks. In such a context, any mechanism that makes patient risk structured and visible (like clinical status columns in DIASYS) can form the foundation for targeted interventions to reduce incidents.

Mechanism of Effect: Clinical Status Sorting on Incident Reduction

Sorting patients based on level of consciousness, fall risk, pressure ulcer risk, pain, malnutrition, functional limitations, social work status, and suicide risk essentially enables "care prioritization" at the patient list level. This causes limited nursing and medical resources to focus first on high-risk patients. This arrangement reduces the risk of "high-risk patients getting lost in the crowd" and decreases the likelihood of delayed detection of consciousness changes, pressure ulcer onset, or worsening mental health issues—all directly linked to serious incidents like falls, bleeding, self-harm, and emergency hospitalizations.

Additionally, the ability to monitor risk column status daily during shift handovers transforms team culture from "reactive" to "preventive," which risk stratification literature identifies as a key factor in reducing incidents.

Expected Outcomes in Dialysis (From Hospital Incident Perspective)

Based on the synthesis of available evidence, it's reasonable to expect that using clinical status sorting in dialysis, along with intervention protocols, will have the greatest impact on reducing the following:

• Falls and related injuries: By sorting patients based on fall scores, consciousness level, and mobility limitations, nurses can more closely monitor high-risk patients during entry and exit, bed transfers, and standing after dialysis. Studies in other hospital settings have shown that fall risk assessment and dashboards, when combined with care bundles, can reduce fall rates.

• Pressure ulcers and skin damage: Daily focus on the "bedsore risk" and "level of caution" columns, combined with care bundles (SSKIN and similar protocols) in ICU and other units, has resulted in significant reductions in hospital-acquired ulcers—a pattern that can be implemented in dialysis.

• Infectious and vascular incidents: Highlighting patients with high-risk vascular access, malnutrition, and mobility problems in the list enables early interventions for infection control and nutrition/mobility improvement, which dialysis safety reviews identify as primary error areas.

• Psychosocial incidents (suicide attempts, treatment abandonment): Regular visibility of the "suicide risk" and "high-risk social work groups" columns in the dashboard facilitates rapid referral to psychologists and social workers. Based on general evidence about risk dashboards and referrals, this can help reduce severe incidents and premature treatment discontinuation.

Proposed Design for Quantitative Impact Assessment in a Dialysis Center

To scientifically evaluate the impact of this capability in DIASYS, a before-and-after study (or intervention center versus control center) could be designed where key hospital incident rates in a specified period are compared with pre-implementation. Metrics could include fall rate per 1,000 dialysis sessions, incidence of grade 2 and higher pressure ulcers, vascular access-related infections, emergency hospitalizations related to hypotension/arrhythmia, and self-harm or treatment abandonment events—all identified as important incidents in hemodialysis safety literature. Alongside these hard metrics, process indicators such as percentage of completed risk scores, response time to high-risk patients, and implementation rate of preventive bundles can be monitored to determine what change in care team behavior produced the observed effect.

Analytical Summary for DIASYS

Given the available evidence on the effectiveness of risk dashboards in EHR, the relative utility of risk scales (Braden, Morse, etc.) in identifying high-risk patients, and the high-risk nature of hemodialysis patients, it can be concluded that sorting clinical conditions in the DIASYS patient list is a structural intervention with real potential for reducing hospital incidents—provided it's connected to intervention protocols and quality metric monitoring.

This capability elevates DIASYS from the level of "recording information" to "active risk management," aligns with international best practices in using EHR data for risk stratification and improving patient safety, and can serve as the foundation for a formal quality improvement program or even multi-center research in Iran.