Computerization of the surgical intensive care unit: improvement of patient care via education

For the past 18 months we have been evaluating and developing a computerized patient-monitoring system in our surgical intensive care unit. Despite the enormous potential for use of such systems, we have been impressed with its underutilization and its failure to yield objective improvement in patient care at our institution and many others. The output of the system was ignored because the decision maker was unable or unwilling to integrate the more sophisticated data presented to him. The computer was relegated to the position of "redundant secretary". In an attempt to reverse this situation, we have developed a multilevel, multigoal educational system employing the computer. We have implemented brief educational programs for use by all unit personnel to explain deviant monitored variables. Given a physiologic subsystem and a particular variable, personnel can: (1) inquire whether or not the variable is deviant; (2) obtain a list of probable causes for the deviation; (3) obtain an explanation of the pathophysiology of particular deviants as well as instruction on how to identify a most probable cause; and (4) inquire how to correct specific deviants. When we monitored the system utilization after implementation of the educational programs, we found all of the system had improved utilization. As a result we have a better educated staff who communicate more effectively, deal with more sophisticated information, and make better decisions with resultant improved patient care. Additionally, the staff is eager to help improve the system. We believe the full potential of such systems can be obtained only through education.