Critical care clinics
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Computers can offer significant enhancement to the monitoring of the critically ill. Their value is derived from improved vigilance, better charting, and an opportunity to assess practitioner compliance with unit protocols. However, their true value can only be attained when they are integrated into a total information system.
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The EMR in the ICU has the utility of providing the necessary information to make sound clinical decisions for critically ill patients. For it to be optimized, the EMR must be more than just what is being replicated in the written record or merely a documentation tool; it must add value that supports and enhances clinical decision support. The EMR is too expensive a tool just to be a computer designed to ease documentation and retrieve data faster. ⋯ It is clear that to analyze some of the outcomes that health care delivery provides, one needs some mechanism to automate the information at the point of care, particularly now that the regulatory agencies are requiring it. Given the fact that there is no single integrated computerized patient record, this becomes the daunting task for the next century. Making it easier for health care providers to interact with the system and providing them with instantaneous feedback that changes their medical decision so they can deliver better care (clinical pathways, clinical practice guidelines) will be the task required of the next generation of CISs.
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The clinical management database utilizes ICU patient data in aggregate to examine quality of care and resource utilization at the population level. As clinicians become accountable for efficiency and quality, this type of database is essential to understand the results of care. This article reviews the challenges of evaluating cost and quality including the potential for bias and measurement error. A practical approach to starting a database is outlined with examples and suggestions.
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Critical care clinics · Jul 1999
ReviewSeverity scoring and outcome assessment. Computerized predictive models and scoring systems.
Severity of illness scoring systems and standardized death ratios are being used with increasing frequency as markers of quality of care and to compare and contrast the performance of ICUs. However, numerous factors unrelated to the quality of care delivered may impact the severity of illness score and standardized death ratios. This article reviews the commonly used severity scoring systems and factors that affect their predictive performance.
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The Internet was created in 1969, when the Advanced Research Projects Agency of the United States Department of Defense fired up an experimental network consisting of only four computers. Over the past five years there has been an exponential explosion in the number of computers added to this network. It is estimated that Internet traffic doubles every 100 days with more than 100 million people worldwide now on-line. ⋯ From recreation to applied science and technology, and from Critical Care Medicine case scenarios to digitized radiology images and pathology specimens, the Internet has become increasingly useful for critical care practitioners. To date, no resource is better equipped to assist critical care providers in many of their daily tasks. This article presents some of the historical developments of the Internet as well as common applications that are useful for critical care practitioners.