Page 83 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

CHAPTER 8: Principles of Medical Informatics and Clinical Informatics in the ICU 51

TABLE 8-1 Studies of EHR Impact on ICU Quality of Care and Their Findings
Study Finding
A 4-year cross-sectional study of 18 quality measures. No association between the duration of EMR use and performance with respect to qual-
ity of care. 33
Study of 3364 hospitals comparing quality of care measures for hospitals with or without fully Significant positive association in 5 of 11 quality measures related to ordering medica-
implemented CPOE systems. tions and in 1 of 9 nonmedication-related quality measures. 34
Automated data capture from ICU devices. Reduces nursing workload. 35
Shown to increase time spent in direct patient care. 36
Better automation and usability ICU. Increased use of HIT was associated with fewer catheter-related infections. 37
To assess the effect of CIS on quality of nutritional support in the ICU. The use of postpyloric feeding tubes and energy (food) delivery increased with CIS,
resulting in significantly less patient weight loss. 38
To study the impact of the use of a reporting tool derived from an ICU-computerized flow sheet Improvements in DVT prophylaxis, GI bleeding prophylaxis, and glucose control in the ICU. 39
on compliance with JCAHO core measures performance.
To compare the impact on patient care of general CPOE system versus a modified system The number of orders written per patient for vasoactive drips, sedative infusions, and
designed specifically for ICU use. ventilation management decreased significantly with the modified CPOE system, how-
ever, no impact on ICU length of stay. 40
Effect of CPOE on prevention of serious medication errors. The rate of serious medication errors decreased by 55% after CPOE implementation. 14
Impact individual electronic medical record surveillance on the risk of ventilator-induced lung injury. The exposure to potentially injurious ventilation decreased after the system implementation. 21
Prospective trial compared a paper-based ICU versus a computerized. The ICU computerization resulted in a significant decrease in the occurrence and sever-
ity of medication errors in the ICU. 41
Study of the impact of implementation of commercially available CPOE on standardized mortal- CPOE introduction was associated with a doubling of mortality. 6
ity in a pediatric ICU.

Outpatient
prescribing
Other clinical systems
Inventory
Emergency visits
Medication
administration
Outpatients visits
Allergy Dispensing Pathology
Administrative systems
Blood bank
Patients
identification Immunization e-prescribing Microbiology
Radiology
Scheduling Medical history Pharmacy Clinical laboratory

Flowsheet (nursing) Clinical decision Dialysis
Barcoding
charting support
ICU
EHR
Outcome Dictation and Inpatient CPOE Catheterization lab
management system transcription
Anesthesia and Surgery
Claims and billing Clinical notes ICU charting Respiratory therapy

Assignment of Physical examination Monitors Ventilators
benefits
Consent for Subspeciality IV pumps
treatment consultation
Medicare claim Diagnoses Pulse oximeters
authorization

FIGURE 8-2. Functional and abstract model of ICU EMR. Central place taken by systems used in ICU. At the side, there are other clinical and administrative systems used to support practice in ICU.

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