Resp Care
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Computer-age technology is changing the face of respiratory therapy as it is that of nearly every other technical field. In some hospital respiratory therapy departments computers are presently being used for a wide range of functions such as blood gas result reporting, billing, budgeting, purchasing, hemodynamic calculations, and respiratory monitoring. Microprocessor-controlled ventilators and respiratory monitoring systems are becoming increasingly utilized. ⋯ Respiratory therapists must recognize and rise to the challenge that computer-age technology presents if they are to continue as intensivists. The worst possible development of the future for respiratory therapy would be for computer-age technology to be applied to respiratory therapy without the input and inclusion of respiratory therapists. The challenge then is to be adequately prepared to utilize and apply this inevitable new computer-age technology.
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Computers are now in widespread use in pulmonary function laboratories, where they have made an important contribution by assisting with complex and repetitive tasks. They can be used to acquire data from testing instruments, make measurements and calculations, and prepare reports. ⋯ As a result of our experience with this system, we have found six definable steps between data acquisition and data interpretation: (1) establish quality instrumentation, (2) establish adequate procedures for test performance, (3) standardize measurement and computational techniques, (4) determine the adequacy and reproducibility of results and apply a test selection, (5) identify the measurements to be used for interpretation, and (6) apply strategies that lead to consistent interpretation of results. Because spirometry and blood gas tests account for the major activities of our pulmonary function laboratory, we have applied these six steps necessary for computer decision-making to these two two tests; however, they are equally applicable to other tests in the pulmonary function laboratory.
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Information handling is an important part of the activities of health care professionals, and the Parkland On-line Information System (POIS)--a computerized hospital information system--was established to more efficiently handle the processing and storage of information in our institution. Computerization of a respiratory therapy department is more effective if done in the context of a comprehensive, integrated hospital information system. ⋯ POIS is an implementation of the IBM Patient Care System. We have found that a computerized hospital information system can facilitate patient care by easing the burden of information processing.
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The addition of computers to pulmonary function laboratories has reduced quality-control problems. After standards for a test have been selected, the computer can enforce adherence to them. The computer can be programmed to perform periodic calibration checks and other self-diagnostic procedures to ensure that instrumentation and human errors have not gone undetected. ⋯ Quality-control samples can be processed more frequently with the use of a computer because this task consumes less time than when done by laboratory personnel. Some disadvantages of quality control that have appeared since the introduction of the computer are the potential for undetected failure of computer hardware and software, a risk that has increased with the increase in software complexity, and the potential for the loss of large amounts of information because of its being stored on a single digital medium. To effect quality control in the pulmonary function laboratory one should (1) ensure that procedures and software conform to standards, (2) follow routine calibration-check procedures, (3) check test results for internal consistency and for consistency with other test results, (4) conduct periodic testing of a quality-control subject or reference sample, (5) continually evaluate software performance, (6) carefully evaluate changes in instrumentation and software, and (7) maintain duplicate copies of data on different types of mass storage media.
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Digital computers are becoming important diagnostic and research tools in the pulmonary function laboratory. Their applications include generating reports, file-keeping analyses of data from spirometry and stress testing procedures, graphically presenting data, and statistically reducing research data. The computer can be used to develop models of the respiratory system that can be practically applied to obtain more detailed information concerning the flow-limiting aspects of airway segments during forced exhalation. With the computer system's intended use in mind, the purchaser should consider a computer system's capacity, the expandability of the system, the manufacturer's reliability and service record, and the availability of necessary software.