Knowledge-Based Systems. Methods for Developing and Evaluating Expert Systems: Development of Computerized Critical Care Protocols-A Strategy That Really Works!

摘要

Our initial goal was to develop protocols to ensure uniform care in both groups of our current randomized clinical trial, “Extracorporeal CO2 Removal for ARDS” (ECCO2R, NIH Grant HL36787). These hypoxemia protocols utilize the bedside intensive care unit (ICU) computer terminal to prompt the clinical care team with therapeutic and diagnostic suggestions. The protocols have been used for over 15,000 hours in 61 adult respiratory distress syndrome (ARDS) patients. 38 of these ARDS patients met extra corporeal membrane oxygenation (ECMO) criteria. The survival of the ECMO criteria ARDS patients was 41%, four times that expected (9%) from historical data (p < 0.003). The four fold increase in survival is surprising. The success of these computer protocols clearly established the feasibility of controlling the therapy of severely ill patients.Over the last four years we have refined the process which we use for generating computerized protocols. The purpose of this paper is to present the six step development strategy which we are successfully using to produce computerized critical care protocols.