title: Online guideline assist in intensive care medicine--is the login-authentication a sufficient trigger for reminders?
abstract: BACKGROUND
  Rising cost pressure due to the implementation of the DRG-System and quality assurance lead to an increased use of therapy standards and standard operating procedures (SOPs) in intensive care medicine. The intention of the German Scientific Society supported project "OLGA" (Online Guideline Assist) is to develop a prototype of a knowledge based system supporting physicians of an intensive care unit in recognizing the indication for and selecting a specific guideline or SOP. While the response of the prototype on user entries can be displayed as a signal on the used workstation itself, the location and time for a reminder of scheduled or missed procedures or reactions to imported information is a difficult issue. One possible approach to this task is the display of non acknowledged reminders or recommendations while logging on to a system. The objective of this study is to analyse user behaviour of the physicians working on the surgical intensive care unit to decide whether the login authentication is a sufficient trigger for clinical reminding.
  
  
  METHODS
  The surgical intensive care unit examined in this study comprises 14 beds. Medical care is provided by physicians working in shifts 24 hours a day, 7 days a week, with two anaesthetists at a time and an additional senior consultant during daytime. The entire documentation (examinations, medication, orders, care) is performed using the patient data management system ICUData. The authentication process of the physicians was logged and analysed.
  
  
  RESULTS
  Throughout the observation period from December 13th 2005 to January 11th 2006 3563 physician logins were counted in total. The mean span between logins was in 11.3 minutes (SD 14.4), the median 7 minutes. The 75% centile was 14 minutes, the 95% centile 38 min. Intervals greater than 60 minutes occurred in 75%, and greater than 90 minutes in 25% of the days.
  
  
  CONCLUSIONS
  It seems reasonable that reminders sent during authentication are able to enforce workflow compliance. It is possible to send notifications caused by external events to the physician depending on the importance of the event. Serious events with high urgency should be reliably passed using wireless pager or handheld technology. It seems that after the implementation of the prototype guideline assist further investigation is needed to monitor changes in authentication behaviour and reactions to the guideline advisory. This is also required to investigate the influence of unit's size, medical specialty and actual ward workload.
authors.affiliation: Clinic for Anesthesiology, Intensive Care Medicine, Pain Management and Palliative Medicine, Universitiy of Giessen, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Röhrig
authors.forename: Markus
authors.initials: M
authors.lastname: Meister
authors.forename: Achim
authors.initials: A
authors.lastname: Michel-Backofen
authors.forename: Martin
authors.initials: M
authors.lastname: Sedlmayr
authors.forename: Dirk
authors.initials: D
authors.lastname: Uphus
authors.forename: Christian
authors.initials: C
authors.lastname: Katzer
authors.forename: Thomas
authors.initials: T
authors.lastname: Rose
mesh_terms: D003422:Critical Care; D003658:Decision Making, Computer-Assisted; D005858:Germany; D017408:Guidelines as Topic; D006801:Humans; D020407:Internet; D010820:Physicians; D017010:Reminder Systems / Q000706:statistics & numerical data*