Does PACS facilitate work practice innovation in the intensive care unit?

Area of Science:

• Medical Informatics
• Clinical Workflow Analysis
• Radiology

Background:

• Picture Archiving and Communication Systems (PACS) facilitate rapid image study delivery to clinicians.
• PACS holds significant potential for improving critical decision-making in Intensive Care Units (ICUs), especially during daily ward rounds.
• Understanding PACS integration into ICU workflows is crucial for optimizing patient care.

Purpose of the Study:

• To examine how image information access via PACS is integrated into ICU ward rounds.
• To determine if PACS implementation drives innovations in ward round practices within ICUs.

Main Methods:

• Observational study of ward rounds across three hospitals with varying PACS and computerization levels.
• Qualitative data collection through interviews with ICU doctors.
• Comparative analysis of PACS utilization and its impact on clinical decision-making.

Main Results:

• Imaging results were infrequently accessed during ward rounds in ICUs with no PACS and those with PACS and bedside computers.
• In an ICU with PACS available at a central workstation, images were frequently viewed and integrated into patient care decisions during rounds.
• The mere presence of bedside computers did not automatically lead to innovative work practices with PACS.

Conclusions:

• PACS utilization and its impact on clinical practice in ICUs are highly context-dependent.
• Accessibility of PACS at a central workstation, rather than just bedside availability, influenced its integration into ward rounds.
• Further research is needed to understand the complexities of ICU workflows and their role in driving practice innovation with PACS.