Proceedings / AMIA ... Annual Symposium. AMIA Symposium
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We present a prototype of a decision support system for anesthesia that applies set covering theory. The system is designed to generate dynamically configured check-lists for intra-operative problems. These lists have the potential to help anesthesiologists detect and manage problems in a timely manner. ⋯ A set covering algorithm that accommodates multiple problem sets was used to implement the prototype. A simulated case and the system behavior are presented. The ultimate goals of a system such as the one presented are to function as an intelligent alarm module for electronic monitors and to facilitate the task of correcting intra-operative problems.
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Comparative Study
Does size matter?--Evaluation of value added content of two decades of successive coding schemes in secondary care.
Over the last two decades there has been a gradual evolution from the use of simple coding schemes to controlled clinical terminologies within clinical information systems in secondary care. This evolution has required significant resources in both the development of the different coding schemes and the cost of hardware, software and human effort in implementation. During this time there has been successively larger and more complex coding schemes available for use in the UK Health Service: Read Codes 4 byte set, Read Codes 5 byte set, ICD-10 and Clinical Terms Version 3. ⋯ The schemes are quantitatively evaluated by measuring their success in providing a concept match for every notion from the CIS and their relative merits are compared. Significant added value has accrued over the years in completeness of the schemes reflected in their increased size. There appears to be justification for the continued development of clinical terminologies to support secondary care.
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Automated physiologic event detection and alerting is a challenging task in the ICU. Ideally care providers should be alerted only when events are clinically significant and there is opportunity for corrective action. However, the concepts of clinical significance and opportunity are difficult to define in automated systems, and effectiveness of alerting algorithms is difficult to measure. ⋯ During a 6-month test period in the trauma ICU at Vanderbilt University Medical Center, 530 alerts were detected in 2280 hours of data spanning 14 patients. Clinical users electronically documented 81% of these alerts as they occurred. Retrospectively classifying documentation based on therapeutic actions taken, or reasons why actions were not taken, provided useful information about ways to potentially improve event definitions and enhance system utility.
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In intensive care physiological variables of the critical-ly ill are measured and recorded in short time intervals. The existing alarm systems based on fixed thresholds produce a large number of false alarms. ⋯ There are various approaches to modeling time-dependent data and also several methodologies for pattern detection in time series. We compare several methodologies de-signed for online detection of measurement artifacts, level changes, and trends for a proper classification of the patient s state by means of a comparative case-study.
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Patient safety assessment in anaesthesia increasingly relies on the monitoring of frequent but merely undesirable events, like hypotension. We report on the design and implementation of such a monitoring system, where 8032 patients were included over a three years period. Thirty two 'Significant Anaesthetic Events' were defined and their occurrence was routinely collected for each patient. ⋯ The system sensitivity to change in the frequency of significant anaesthetic events was investigated by a controlled intervention, designed to increase the incidence of bradycardia by changing anxyolitic medication. During the intervention, the incidence of bradycardia doubled, while the incidence of other undesirable events was not affected. The system described for the collection of significant anaesthetic events was easy to set up, sensitive to changes and provided valuable tools in performance monitoring.