Abstract
Computerized protocols were created to direct the management of arterial oxygenation in critically ill ICU patients and have now been applied routinely, 24 hours a day, in the care of 80 such patients. The protocols used routine clinical information to generate specific instructions for therapy. We evaluated 21,347 instructions by measuring how many were correct and how often they were followed by the clinical staff. Instructions were followed 63.9% of the time in the first 8 patients and 92.3% in the subsequent 72 patients. Instruction accuracy improved after the initial 8 patients, increasing from 71.5% of total instructions to 92.8%. Instruction inaccuracy was primarily caused by software errors and inaccurate and untimely entry of clinical data into the computer. Software errors decreased from 7.2% in the first 8 patients to 0.8% in subsequent patients, while data entry problems decreased from 7.5% to 4.2%. We also assessed compliance with the protocols in a subset of 12 patients (2637 instructions) as a function of 1) the mode of ventilatory support, 2) whether the instruction was to increase or decrease the intensity of therapy or to wait for an interval of time and 3) whether the instruction was ‘correct’ or ‘incorrect’. The mode of ventilatory support did not affect compliance with protocol instructions. Instructions to wait were more likely to be followed than instructions to change therapy. Ninety-seven percent of the correct instructions were followed and 27% of the incorrect instructions were followed. The major problem in creating the protocols was obtaining clinician agreement on protocol logic and their commitment to utilize it clinically. The major problem in implementing the protocols was obtaining accurate and timely data entry. We conclude that computerized protocols can direct the clinical care of critically ill patients in a manner that is acceptable to clinicians.
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Henderson, S., Crapo, R.O., Wallace, C.J. et al. Performance of computerized protocols for the management of arterial oxygenation in an intensive care unit. J Clin Monit Comput 8, 271–280 (1991). https://doi.org/10.1007/BF01739128
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DOI: https://doi.org/10.1007/BF01739128