Improved consistency in interpretation and management of cardiovascular variables by intensive care staff using a...

To investigate the potential of a computerised decision-support system (CDSS) to improve consistency of haemodynamic evaluation and treatment suggestions by intensive care unit clinical staff with different levels of expertise and experience.

Prospective observational study in a tertiary general ICU, of 20 patients admitted after elective cardiac surgery and assessed by staff specialists, senior registrars, registrars and nurses.

A CDSS was used to display key cardiovascular variables, including mean systemic filling pressure analogue (Pmsa), heart efficiency (Eh) and vascular resistance (SVR). Staff were asked to score Pmsa, Eh and SVR ranging from -5 (grossly subnormal) through 0 (normal) to 5 (grossly supranormal), first without and then with access to the CDSS. Recommendations for therapeutic interventions were recorded. Maximal differences (diffmax) and the proportion of minimal disagreement (diffmin) between staff were evaluated.

Without use of the CDSS, Pmsa was commonly underestimated, Eh was overestimated, and there was no clear trend for SVR, compared with estimations using the CDSS. Diffmax was reduced and diffmin was increased after access to the CDSS. Agreement between all categories of staff on therapeutic interventions increased from four to 18 patients after access to the CDSS.

Use of a CDSS significantly improved the consistency between categories of clinical ICU staff in assessing the cardiovascular status and making management decisions in postoperative cardiac surgery patients.