105 Effects of a specifically-designed intensive care information system length of stay and mortality
| العنوان: | 105 Effects of a specifically-designed intensive care information system length of stay and mortality |
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| المؤلفون: | Movschin Marie, Brisson Hélène, Rouby Jean-Jacques, Lu Qin, Vezinet Corinne, Bouhemad Belaid, Bodin Liliane, Arbelot Charlotte |
| المصدر: | BMJ Quality & Safety. 19:A72-A73 |
| بيانات النشر: | BMJ, 2010. |
| سنة النشر: | 2010 |
| مصطلحات موضوعية: | Gynecology, medicine.medical_specialty, Pediatrics, Sequential organ failure assessment, Critically ill, Tel aviv, business.industry, Health Policy, Acute respiratory disease, Patient care, Order entry, SAPS II, Intensive care, medicine, business |
| الوصف: | Introduction An intensive care information system (ICIS) has numerous advantages. It enables all the patients9 data to be collected in a “computer file”. The automatic acquisition of data reduces human error, and computerised physician order entry limit errors in administering medication. Thanks to computerised data, the creation of a “clinical decision support system” enables diagnosis optimisation and follow-up of treatments. The goal of this study was to evaluate the impact of a personalised ICIS on critically ill patients9 mortality and length of stay in the intensive care unit (ICU). Materials and methods The system chosen for Multidisciplinary ICU (12 beds) of Pitie-Salpetriere hospital in Paris was the program Metavision (IMDsoft, Tel Aviv, Israel). It is an adjustable system, offering the possibility of being completely reformatted and adapted according to specific needs. A team consisting of doctors, nurses, auxiliary nurses, and monitors was trained for 2 weeks to use the program. Then, for 1 month, the ICIS was personalised for the unit before being implemented. After defining the various clinical, biological, and radiological parameters indispensable for diagnosis and follow-up of acute respiratory disease, haemodynamic, renal, and hepatic failures, screens were created, integrating pertinent parameters in the form of tables and graphics. These screens enable all the relevant elements to be grouped together, but also allow the visualisation of their evolution along time. We compared the Simplified Acute Physiology Score (SAPS II) and the Sequential Organ Failure Assessment (SOFA) at patient9s admission, length of patients9 stay in the ICU, and mortality over two 6-month periods: before the implementation of Metavision from June to November 2008, and after implementation, from March to August 2009. Data were compared between groups by a Mann–Whitney test (median and IQR 25–75%), and a χ 2 test. The first 3 months following the implementation of Metavision were not taken into account, in order to exclude the difficulties inherent to the implementation of a new computerised system. Results One hundred twelve patients were hospitalised between June and November 2008, and 160 between March and November 2009. SAPS II and SOFA scores showed no difference between the two groups: (SAPS II: 39 (26–54) vs 44 (28–59), p=0.7, SOFA: 6 (3–10) vs 6 (4–10), p=0.49). The length of stay in intensive care was shortened by 2 days after implementation of Metavision: 9 (5–20) versus 7 (3.5–14), p=0.02. A trend was observer towards a decrease in mortality: 17% to 14.5%, p=0.6. Discussion The interest of the system we have chosen is its adjustability, its ability to combine on the same screen (“clinical decision support screen”), a high number of clinical, biological, or radiological data. These screens enable the assessment of therapies on patients9 organ failures. ICIS enables optimisation of patient9s care, which may explain the reduction in duration of patients9 stay in the ICU. It overcomes the usual limits of ICIS consist of an imperfect adaptation to specific medical needs. Conclusion A specifically-designed intensive care information system enables improvement of patient care, and reduction of the length of stay in the ICU. It requires a substantial investment from physician regarding learning programs and creating personalised tools for diagnosis and follow up assistance. It also requires a close collaboration between physicians and computer scientists. Introduction L9informatisation d9un service de reanimation a de nombreux avantages. Elle permet de rassembler dans le « dossier informatique », toutes les donnees des patients. L9acquisition automatique des donnees diminue l9erreur humaine, et les logiciels de prescriptions limitent les erreurs d9administration de medicament. Grâce aux donnees informatisees, la creation d9un « Systeme d9aide aux decisions medicales » permet d9optimiser le diagnostic et le suivi des therapeutiques. Le but de cette etude etait d9evaluer l9impact de l9informatisation personnalisee du service sur la mortalite et la duree de sejour en reanimation. Materiel et methode Le systeme choisit pour informatiser le service de Reanimation Polyvalente (12 lits) est le logiciel Metavision (IMDsoft, Tel Aviv, Israel). Ce systeme est modulable. Il est livre avec la possibilite d9etre completement remis en forme et adapte en fonction des besoins du service. Une equipe composee de medecins, infirmiers, aides-soigants et surveillants a ete formee au logiciel pendant deux semaines. Puis pendant un mois le dossier a ete personnalise pour le service avant d9etre implante. L9accent a ete mis sur la creation d9 « ecrans d9aide au diagnostic ». Apres avoir defini les differents parametres cliniques, biologiques et radiologiques indispensables au diagnostic et a la prise en charge d9une pneumopathie, d9une defaillance hemodynamique, renale et hepatique, des ecrans ont ete crees en integrant ces parametres sous formes de tableau et de graphique. Ces ecrans permettent de regrouper tous les elements pertinents mais aussi de visualiser leur evolution dans le temps. Nous avons compare les scores d9Indice de Gravite Simplifie (IGS) et de defaillance d9organe (SOFA) a l9admission, la duree de sejour et la mortalite sur deux periodes de six mois: avant l9implantation du logiciel de juin a novembre 2008 et apres l9implantation de Mars a Aout 2009. Les deux groupes de patients ont ete analyses par un test de Mann-Whitney (mediane et 25–75% Interquartile) et un test de Chi-2. Les trois premiers mois suivant la mise en place du systeme n9ont pas ete pris en compte pour exclure les difficultes inherentes a la mise en place d9un nouveau systeme. Resultats Cent douze patients ont ete hospitalises entre juin et novembre 2008 et 160 entre mars et novembre 2009. Les scores d9IGS et de SOFA n9etaient pas differents entre les 2 groupes: [IGS: 39 (26–54) vs 44 (28–59), p=0.7; SOFA: 6 (3–10) vs 6 (4–10), p=0.49]. La duree d9hospitalisation en reanimation a ete raccourcie de 2 jours apres l9implantation du logiciel: 9 (5–20) vs 7 (3.5–14), p=0.02. La mortalite est passee de 17% a 14.5%, p=0.6. Discussion L9interet du systeme que nous avons choisi est sa plasticite, sa capacite a regrouper sur un meme ecran d9aide au diagnostic un nombre d9informations tres variables qu9elles soient cliniques, biologiques ou radiologiques. Ces ecrans permettent precisement d9evaluer et de suivre l9evolution des defaillances d9organes des patients. L9informatisation permet d9optimiser la prise en charge du patient ce qui pourrait expliquer la diminution de duree sejour en reanimation. Les limites des systemes informatiques sont qu9ils ne sont pas crees par les medecins et donc parfois imparfaitement adaptes aux besoins medicaux. Conclusion L9informatisation personnalisee d9un service permet d9ameliorer la prise en charge des patients et de raccourcir la duree de sejour en reanimation. Elle necessite un investissement important de la part des medecins en terme d9apprentissage du logiciel et de la creation d9outils personnalises d9aide au diagnostic. Elle requiert aussi une collaboration etroite entre medecins et informaticiens du systeme adopte et de l9hopital. |
| تدمد: | 2044-5423 2044-5415 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_________::e94e7c40e28b76a7087f4f6d54a3470dTest https://doi.org/10.1136/qshc.2010.041624.25Test |
| رقم الانضمام: | edsair.doi...........e94e7c40e28b76a7087f4f6d54a3470d |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 20445423 20445415 |
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