Comparison of nurse and computer charting of physiological variables in an intensive care unit

To compare charting of physiological parameters manually by nurses and automatically by computer and so decide whether this task could accurately be performed by computer.

101 consecutive patients admitted for tertiary neonatal intensive care.

Direct comparison of 48 hours of data collected by both methods. Computer data stored each second and the hourly median compared with the single hourly value noted by the nurse.

All patients were monitored by standard patient monitor and a computer. Four physiological parameters were compared between nurse and computer (both derived information from the standard patient monitor): heart rate, transcutaneous oxygen, mean blood pressure, central temperature. A random 51% of patients had the computer data displayed as trends at the cotside. Comparison of the hourly nurse observation and a computer hourly median value. Computer data was compared before and after the removal of artifact. In addition, the effects on nursing observations of either display or non display of the computer trend data was assessed.

Nurse and computer observations were statistically significantly different (p < 0.001), though these were not clinically important. Nurses tended to note a higher figure than the computer median. The cotside display of computer data improved consistency between the nurse and computer observations. Artifact present in the data had little influence on the accuracy of the computer median value.

Computer systems can accurately chart physiological data, providing a more flexible record with a minimal risk to data reliability from artifact.