A clinical decision support system prototype for cardiovascular intensive care.
This paper describes the development and validation of a decision-support system prototype that can help manage hypovolemic hypotension in the Cardiovascular Intensive Care Unit (CVICU). The prototype uses physiologic pattern-matching, therapeutic protocols, computational drug-dosage response modeling and expert reasoning heuristics in its selection of intervention strategies and choices. As part of model testing, the prototype simulated real-time operation by processing historical physiologic and intervention data on a patient sequentially, generating alerts on questionable data, critiques of interventions instituted and recommendations on preferred interventions. Bench-testing with 399 interventions from 13 historical cases showed therapies for bleeding and fluid replacement proposed by the prototype were significantly more consistent (p < 0.0001) than those instituted by the staff when compared against expert critiques (80% versus 44%). This study has demonstrated the feasibility of formalizing hemodynamic management of CVICU patients in a manner that may be implemented and evaluated in a clinical setting.
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Department of Accounting and Management Information Systems, Faculty of Business, University of Alberta, Canada.
D000416:Alberta; D001810:Blood Volume; D002985:Clinical Protocols; D003325:Coronary Care Units; D003363:Cost Control; D003661:Decision Support Techniques; D003663:Decision Trees; D004305:Dose-Response Relationship, Drug; D005069:Evaluation Studies as Topic; D005103:Expert Systems; D005440:Fluid Therapy / Q000191:economics; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000503:physiopathology / Q000628:therapy*; D007902:Length of Stay; D008991:Monitoring, Physiologic; D013813:Therapy, Computer-Assisted