Impact of a computerized information system on quality of nutritional support in the ICU.
OBJECTIVE
In intensive care units (ICUs), patient outcome depends on quality of nutritional support. We investigated the effect of computerized information systems (CISs) on quality of nutritional support by comparing two ICUs with or without CIS and burned patients before and after CIS implementation.


METHODS
Part 1 was a 2-wk prospective survey in two units of a surgical ICU: unit A (11 beds) without CIS and unit B (four beds) with CIS. Part 2 consisted of two 18-mo periods in burn patients before and after CIS implementation. Nurses and doctors belonged to the same team; procedures were identical. A computer page was configured to retrieve data related to nutritional support.


RESULTS
A total of 1313 ICU days were analyzed in 109 patients. Patients' characteristics were similar in parts 1 and 2. In part 1, nutritional support was required 38% of days. Nutritional route was similar but data were more frequently missing in unit A. Energy delivery was higher with CIS but below target values in both units (31+/-11% of target in unit A, 77+/-4% in unit B). Computations were incomplete and time consuming for unit A versus B (11+/-2 versus 2+/-1 min/patient, P<0.0001). In part 2, in the 54 burn patients, use of postpyloric feeding tubes and energy delivery increased with CIS, resulting in less weight loss.


CONCLUSIONS
Computerized information systems favored standardization of nutritional care and monitoring, thus decreasing time required for writing and computations. Follow-up was improved and nutrient delivery was closer to target values, thus increasing quality of care. In burn patients, the better data visibility was associated with a significant improvement in nutrient delivery.
Berger
Mette M
MM
Surgical ICU and Burns Center, University Hospital (CHUV), Lausanne, Switzerland. mette.berger@chuv.hospvd.ch
Revelly
Jean-Pierre
JP
Wasserfallen
Jean-Blaise
JB
Schmid
Aline
A
Bouvry
Sylvie
S
Cayeux
Marie-Christine
MC
Musset
Myriam
M
Maravic
Philippe
P
Chiolero
René L
RL
D002056:Burns / Q000628:therapy*; D003422:Critical Care / Q000592:standards; D016638:Critical Illness / Q000628:therapy; D002149:Energy Intake; D004750:Enteral Nutrition / Q000592:standards*; D005260:Female; D006751:Hospital Information Systems; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D011446:Prospective Studies; D011787:Quality of Health Care; D016896:Treatment Outcome