Concepts Issues and Standards. Topical Issues in Medical Informatics: Computerized Clinical Protocols in an Intensive Care Unit: How Well Are They Followed?

摘要

Computerized protocols were created to direct the management of arterial hypoxemia in critically ill patients with adult respiratory distress syndrome (ARDS) and have now been applied routinely, 24 hours a day, in the care of 36 such patients. We evaluated the performance of the protocols by measuring how often the clinical staff followed protocol instructions. Since compliance with the protocols could also vary depending on the type of therapy, we assessed compliance with the protocols as a function of 1) the method of artificially ventilating the patients, 2) whether the protocol instruction was to increase or decrease the intensity of therapy or to wait for an interval of time and 3) whether the computer instruction was “correct” or “incorrect.” A total of 7,663 instructions were evaluated. The clinical staff followed protocol instructions 63.8% of the time in the first 8 patients and 90.8% of the time in the subsequent patients. Instructions to wait were more likely to be followed than instructions to change therapy. There was no difference in compliance between instructions to increase and those to decrease the intensity of therapy. “Incorrect” instructions were followed 27% of the time. These instructions may not have been clinically important. The mode of ventilation therapy did not affect compliance with protocol instructions. We conclude that protocols can direct the clinical care of critically ill patients in a manner that is acceptable to experienced clinicians.