J Med Syst
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This paper explores the role of clinical decision support systems (CDSS) in facilitating communication between physicians, nurses, patients and family members. Thirty-three critical care unit nurses and physicians were interviewed regarding the APACHE III CDSS. ⋯ These forecasts are used to advocate for care decisions with other disciplines, patients and their family members. Implications for professional practice and recommendations for future research are described.
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Despite the considerable number of publications on ICU patient flow and analysis of its variability, a basic and practically important question remained unanswered: what maximum number of elective surgeries per day should be scheduled (along with the competing demand from emergency surgeries) in order to reduce diversion in an ICU with fixed bed capacity to an acceptable low level, or prevent it at all? The goal of this work was to develop a methodology to answer this question. An ICU patient flow simulation model was developed to establish a quantitative link between the daily load leveling of elective surgeries (elective schedule smoothing) and ICU diversion. ⋯ However this would require bumping 'extra' daily surgeries to the block time day of another week which could be up to 2 months apart. Because not all patients could wait that long for their elective surgery, another more practical scenario was tested that would also result in a very low ICU diversion: bumping 'extra' daily elective surgeries within less than 2 weeks apart, scheduling not more than five elective surgeries per day, and strict adherence to the ICU admission/ discharge criteria.
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The integration of computer systems into clinical practice is a consequence of the growing sophistication of medical machinery. The fact that patient management in large institutions is handled by complex information systems brings about the need for integration between applications on both sides. The paper describes a prototype for automatic data collection from intensive care devices developed at Pedro Hispano Hospital in Portugal. ⋯ Automatic acquisition eliminates transcription errors, improves the quality of records and allows the assembly of large electronic archives of vital sign data. The concern with data archiving in standard formats opens many possibilities for further analysis of the collected data sets. The possibility of communicating via the HL7 standard makes the whole system easily interoperable with applications in related domains.