Computerized decision support in adult and pediatric critical care

Abstract

Computerized decision support (CDS) is the most advanced form of clinical decision support available and has evolved with innovative technologies to provide meaningful assistance to medical professionals. Critical care clinicians are in unique environments where vast amounts of data are collected on individual patients, and where expedient and accurate decisions are paramount to the delivery of quality healthcare. Many CDS tools are in use today among adult and pediatric intensive care units as diagnostic aides, safety alerts, computerized protocols, and automated recommendations for management. Some CDS use have significantly decreased adverse events and improved costs when carefully implemented and properly operated. CDS tools integrated into electronic health records are also valuable to researchers providing rapid identification of eligible patients, streamlining data-gathering and analysis, and providing cohorts for study of rare and chronic diseases through data-warehousing. Although the need for human judgment in the daily care of critically ill patients has limited the study and realization of meaningful improvements in overall patient outcomes, CDS tools continue to evolve and integrate into the daily workflow of clinicians, and will likely provide advancements over time. Through novel technologies, CDS tools have vast potential for progression and will significantly impact the field of critical care and clinical research in the future.

Health care professionals’ knowledge of commonly used sedative, analgesic and neuromuscular drugs: A single center (Rambam Health Care Campus), prospective, observational survey

“…In different fields of medicine, including intensive care, strong evidence supports the use of clinical decision support tools to achieve improvement in care delivery and adherence to medical guidelines. [18,19] Incorporation of automated clinical decision support tools into an electronic health record system of mechanically ventilated patients may assist caregivers in correct selection of medications and may prevent insufficient or excessive sedation and analgesia.…”

Development and validation of a nomogram for predicting self-propelled postpyloric placement of spiral nasoenteric tube in the critically ill: Mixed retrospective and prospective cohort study

“…In the evolution of decision support tools for critical care, bedside computerized as well as graphical decision-making tools including decision tree and nomogram have gained gradual acceptance for improved diagnosis, monitoring, risk prediction, treatment and outcome [10,12,13,31]. However, although decision trees are simple to comprehend, they are often unstable and relatively inaccurate, especially for data including categorical variables with different number of levels [32].…”

Clinical Decision Support for Pediatric Blood Product Prescriptions

“…28 CDS has been successfully utilized in the intensive care settings where data have helped support critical decisions that must be made in a timely fashion. 29 Not all CDS tools are equally effective. Certain properties of CDS tools have been shown to augment their effectiveness.…”