A strategy for development of computerized critical care decision support systems

Area of Science:

• Medical Informatics
• Critical Care Medicine
• Health Systems Research

Background:

• Hospital Information Systems (HIS) and Intensive Care Unit (ICU) Patient Data Management Systems (PDMS) offer benefits beyond data management, primarily through decision support.
• Existing HIS and PDMS often lack robust decision support capabilities, particularly within the critical care environment.
• The HELP system at LDS Hospital demonstrates a comprehensive HIS with integrated decision support tools.

Purpose of the Study:

• To evaluate the effectiveness of computer-assisted clinical decision support protocols in the ICU.
• To assess the impact of these protocols on patient management, specifically for adult respiratory distress syndrome (ARDS).
• To determine the influence of decision support systems on patient outcomes, including survival rates.

Main Methods:

• Development and clinical validation of computer protocols for mechanical ventilation management in ARDS patients.
• Utilization of bedside ICU computer terminals to prompt clinical teams with therapeutic and diagnostic suggestions.
• Application of protocols in paper and computerized formats for over 40,000 hours across more than 125 ARDS patients.

Main Results:

• Protocols guided patient care for 94% of the observed time, with deviations due to specific clinical states (e.g., hemodynamic instability, transport).
• In patients meeting criteria for extracorporeal membrane oxygenation (ECMO), survival was 41% compared to an expected 9% from historical data.
• This represents a four-fold increase in survival for ECMO-eligible ARDS patients (p < 0.0002).

Conclusions:

• Integrated HIS and PDMS with decision support tools, particularly for mechanical ventilation in ARDS, offer significant clinical benefits.
• Computerized protocols can effectively guide critical care management, leading to improved patient outcomes and survival.
• The HELP system's decision support protocols demonstrate a substantial positive impact on ARDS patient survival, especially in severe cases requiring ECMO.