Proceedings / AMIA ... Annual Symposium. AMIA Symposium
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Randomized Controlled Trial Multicenter Study Clinical Trial
Efficacy of computerized decision support for mechanical ventilation: results of a prospective multi-center randomized trial.
200 adult respiratory distress syndrome patients were included in a prospective multicenter randomized trial to determine the efficacy of computerized decision support. The study was done in 10 medical centers across the United States. There was no significant difference in survival between the two treatment groups (mean 2 = 0.49 p = 0.49) or in ICU length of stay between the two treatment groups when controlling for survival (F(1df) = 0.88, p = 0.37.) There was a significant reduction in morbidity as measured by multi-organ dysfunction score in the protocol group (F(1df) = 4.1, p = 0.04) as well as significantly lower incidence and severity of overdistension lung injury (F(1df) = 45.2, p < 0.001). ⋯ Protocols were used for 32,055 hours (15 staff person years, 3.7 patient years or 1335 patient days). Protocols were active 96% of the time. 38,546 instructions were generated. 94% were followed. This study indicates that care using a computerized decision support system for ventilator management can be effectively transferred to many different clinical settings and significantly improve patient morbidity.
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A security system was developed as part of a patient records research database project intended for both local and multi-site studies. A comprehensive review of ethical foundations and legal environment was undertaken, and a security system comprising both administrative policies and computer tools was developed. ⋯ Systems fitting this model were implemented at two academic medical centers. Security features of commercial database systems were found to be adequate for basic enforcement of approved research protocols.
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Continuity of care necessitates communication between the primary providers of inpatient and outpatient care. Communication requires identification of providers in addition to clinical information. We have constructed a web-based SignOut System to improve provider identification. ⋯ When analyzed by attending type (i.e., service and private,) the SignOut System correctly identified 86% of service providers in contrast to the hospital bed census that correctly identified 57% of service providers. Both the SignOut System (100%) and the hospital bed census (95%) had superior results in identifying private attendings. The web-based technology provides a familiar user interface and ubiquitous workstation access.
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Process modeling is explored as an approach for prospectively managing the quality of a telemedicine/telehealth service. This kind of prospective quality management is more appropriate for dynamic health care environments compared to traditional quality assurance programs. A vector model approach has also been developed to match a process model to the needs of a particular site.
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Comparative Study
Making ICU alarms meaningful: a comparison of traditional vs. trend-based algorithms.
Much of the work in the ICU revolves around information that is recorded by electronic devices. Such devices typically incorporate simple alarm functions that trigger when a value exceeds predefined limits. Depending on the parameter followed, these "boundary based" alarms tend to produce vast numbers of false alarms. ⋯ Results show a ten-fold increase in positive predictive value of alarms from 3% using monitor alarms to 32% using the module. The module's overall sensitivity was 82%, failing to detect 18% of significant alarms as defined by the ICU staff. The results suggests that implementation of such methodology may assist in filtering false and insignificant alarms in the ICU setting.