Improving pulmonary artery catheter waveform interpretation

The pulmonary artery catheter (PAC) guides diagnosis and treatment in the intensive care unit (ICU), but studies have shown that physicians and nurses collectively have inadequate skill in interpreting PAC waveforms. We have developed a Web-based application that provides physicians and nurses with rapid access to relevant PAC-related content for use in patient care situations in real time. The application begins with a visual index that assists in the recognition of both normal and abnormal waveforms and provides waveform-specific links to concise advice on making accurate pressure measurements, troubleshooting system problems, and avoiding complications of catheter use. Evaluation of the application's efficacy will consist of a before-and-after trial to determine whether the application improves test performance in the areas of waveform recognition, accuracy of measurement, and appropriateness of action. We have completed the pre-intervention testing of nurses in the medical intensive care unit and found performance ranging from a mean of 68% for those with less than two years of experience to a mean of 76% for those with more than 6 years of experience.