TY - JOUR
T1 - Improved consistency in interpretation and management of cardiovascular variables by intensive care staff using a computerised decision-support system
AU - Rangappa, Ranganatha
AU - Sondergaard, Soren
AU - Aneman, Anders
PY - 2014/3
Y1 - 2014/3
N2 - Objective: 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. Design, setting and participants: 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. Main outcome measures: 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. Results: 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. Conclusion: 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.
AB - Objective: 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. Design, setting and participants: 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. Main outcome measures: 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. Results: 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. Conclusion: 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.
UR - http://www.scopus.com/inward/record.url?scp=84908256810&partnerID=8YFLogxK
M3 - Article
C2 - 24588436
AN - SCOPUS:84908256810
SN - 1441-2772
VL - 16
SP - 48
EP - 53
JO - Critical Care and Resuscitation
JF - Critical Care and Resuscitation
IS - 1
ER -