Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Mar 2009
ReviewHow to implement information technology in the operating room and the intensive care unit.
The number of operating rooms and intensive care units looking for a data management system to perform their increasingly complex tasks is rising. Although at this time only a minority is computerized, within the next few years many centres will start implementing information technology. The transition towards a computerized system is a major venture, which will have a major impact on workflow. ⋯ Published papers on this subject are predominantly single- or multi-centre implementation reports. The general principles that should guide such a process are described. For healthcare institutions or individual practitioners that plan to undertake this venture, the implementation process is described in a practical, nine-step overview.
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Best Pract Res Clin Anaesthesiol · Mar 2009
ReviewComputerized physician order entry in critical care.
Computerized physician order entry means prescribing of medication and ordering laboratory tests or radiology examinations in an electronic way instead of using paper forms. In itself, it offers advantages such as legible orders, faster order completion, inventory management and automatic billing. If combined with clinical decision support, the real benefits of CPOE become apparent in the first place by prevention of medication errors and adverse drug events. ⋯ Therefore, and for reasons of end-user acceptance, implementation is challenging. CPOE has the potential for significant economic saving. However, the initial implementation cost is high.
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Variation in clinical practice impedes control, is associated with unwanted and widespread error, and may preclude replicability. Methodologic replicability enhances our ability to detect signals of interest by both increasing the signal through consistent application of the intervention, and by reducing the obscuring effects of noise. Decision-support tools are intended to standardize some aspect of clinical care and thereby help lead to uniform implementation of clinical interventions. ⋯ Development of such protocols has required around-the-clock implementation for patient management because of the influence of patient history and previous patient states on the output of the computer protocol. Three successful computer protocols for management of blood glucose provide compelling examples. This clinician driven "bottom-up" approach complements the common information technology service driven "top-down" approach to clinical problems.
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Best Pract Res Clin Anaesthesiol · Mar 2009
ReviewMachine learning techniques to examine large patient databases.
Computerization in healthcare in general, and in the operating room (OR) and intensive care unit (ICU) in particular, is on the rise. This leads to large patient databases, with specific properties. ⋯ Although the number of potential applications for these techniques in medicine is large, few medical doctors are familiar with their methodology, advantages and pitfalls. A general overview of machine learning techniques, with a more detailed discussion of some of these algorithms, is presented in this review.