A strategy for development of computerized critical care decision support systems.
It is not enough to merely manage medical information. It is difficult to justify the cost of hospital information systems (HIS) or intensive care unit (ICU) patient data management systems (PDMS) on this basis alone. The real benefit of an integrated HIS or PDMS is in decision support. Although there are a variety of HIS and ICU PDMS systems available there are few that provide ICU decision support. The HELP system at the LDS Hospital is an example of a HIS which provides decision support on many different levels. In the ICU there are decision support tools for antibiotic therapy, nutritional management, and management of mechanical ventilation. Computer protocols for the management of mechanical ventilation (respiratory evaluation, ventilation, oxygenation, weaning and extubation) in patients with adult respiratory distress syndrome ((ARDS) have already been developed and clinically validated at the LDS Hospital. These protocols utilize the bedside intensive care unit (ICU) computer terminal to prompt the clinical care team with therapeutic and diagnostic suggestions. The protocols (in paper flow diagram and computerized form) have been used for over 40,000 hours in more than 125 adult respiratory distress syndrome (ARDS) patients. The protocols controlled care for 94% of the time. The remainder of the time patient care was not protocol controlled was a result of the patient being in states not covered by current protocol logic (e.g. hemodynamic instability, or transport for X-Ray studies). 52 of these ARDS patients met extra corporal membrane oxygenation (ECMO) criteria. The survival of the ECMO criteria ARDS patients was 41%, four times that expected (9%) from historical data (p less than 0.0002).(ABSTRACT TRUNCATED AT 250 WORDS)
East
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LDS Hospital, Pulmonary Division, Salt Lake City, UT 84143.
Morris
A H
AH
Wallace
C J
CJ
Clemmer
T P
TP
Orme
J F
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Weaver
L K
LK
Henderson
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S
Sittig
D F
DF
D001291:Attitude of Health Personnel; D002985:Clinical Protocols / Q000592:standards*; D003422:Critical Care; D003660:Decision Support Systems, Management / Q000592:standards*; D006282:Health Personnel / Q000193:education; D006801:Humans; D010348:Patient Care Team; D011367:Professional Staff Committees / Q000458:organization & administration; D012986:Software Validation