The impact of PACS on clinician work practices in the intensive care unit: a systematic review of the literature.
OBJECTIVE
To assess evidence of the impact of Picture Archiving and Communication Systems (PACS) on clinicians' work practices in the intensive care unit (ICU).


METHODS
We searched Medline, Pre-Medline, CINAHL, Embase, and the SPIE Digital Library databases for English-language publications between 1980 and September 2010 using Medical Subject Headings terms and keywords.


RESULTS
Eleven studies from the USA and UK were included. All studies measured aspects of time associated with the introduction of PACS, namely the availability of images, the time a physician took to review an image, and changes in viewing patterns. Seven studies examined the impact on clinical decision-making, with the majority measuring the time to image-based clinical action. The effect of PACS on communication modes was reported in five studies.


CONCLUSIONS
PACS can impact on clinician work practices in three main areas. Most of the evidence suggests an improvement in the efficiency of work practices. Quick image availability can impact on work associated with clinical decision-making, although the results were inconsistent. PACS can change communication practices, particularly between the ICU and radiology; however, the evidence base is insufficient to draw firm conclusions in this area.


CONCLUSIONS
The potential for PACS to impact positively on clinician work practices in the ICU and improve patient care is great. However, the evidence base is limited and does not reflect aspects of contemporary PACS technology. Performance measures developed in previous studies remain relevant, with much left to investigate to understand how PACS can support new and improved ways of delivering care in the intensive care setting.
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, The University of New South Wales, Sydney, Australia. i.hains@unsw.edu.au
Isla M
IM
Hains
Andrew
A
Georgiou
Johanna I
JI
Westbrook
D003142:Communication; D003657:Decision Making; D004526:Efficiency; D006801:Humans; D007362:Intensive Care Units; D007400:Interprofessional Relations; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011873:Radiology Information Systems; D013673:Technology Assessment, Biomedical; D013997:Time Factors