Multicenter Validation of a Computer-Based Clinical Decision Support Tool for Glucose Control in Adult and Pediatric Intensive Care Units

Thompson, B. Taylor; Orme, James F.; Zheng, Hui; Luckett, Peter M.; Truwit, Jonathon D.; Willson, Douglas F.; Hite, R. Duncan; Brower, Roy G.; Bernard, Gordon R.; Curley, Martha A. Q.; Steingrub, Jay S.; Sorenson, Dean K.; Sward, Katherine; Hirshberg, Ellie; Morris, Alan H.

doi:10.1177/193229680800200304

Cited by 45 publications

(50 citation statements)

References 21 publications

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“…Ventilator fraction of inspired oxygen [41] Pressure support ventilation [42] Antibiotic recommendation [43,44] Blood glucose control [46][47][48] Sepsis [21] Heparin dosing after myocardial infarction [45] Research Mortality prediction [29] Prediction of fluid requirement [53] Predictive alerts for hemodynamic instability [49][50][51] Ventilator settings [76] Prediction of dialysis need [52] Insulin e-protocol [54,85] Pediatric and neonatal critical care Diagnostic ISABEL (www.isabelhealthcare.com) [59,86] SimulConsult (www.simulconsult.com) [87] MEDITEL pediatric diagnostic system [58] Outcome prediction and severity of illness [55][56][57] Alert and Reminder Drug interaction [62] Prescription errors and adverse drug events [18,61] Parenteral nutrition orders [61] NICU pulse oximeter [60] Protocol/Procedure Blood transfusions [63] Medications [61] Parenteral nutrition [64] Management Oxygen in ventilated newborns [68] Antibiotic recommendation [44,65] Blood glucose control [69] Medication information databases [88] Medication dosing calculators [61] Ventilator management in neonates [66,67] Research Virtual PICU (www.pi...…”

Section: Type Of Support Tool Example or Subjectmentioning

confidence: 99%

Computerized decision support in adult and pediatric critical care

Williams¹,

Bratton²

2013

WJCCM

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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.

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Section: Type Of Support Tool Example or Subjectmentioning

confidence: 99%

Computerized decision support in adult and pediatric critical care

Williams¹,

Bratton²

2013

WJCCM

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“…23,37,38 One open-loop example of this type is the eProtocol-insulin algorithm. 39 Alternatively, the Glucose Regulation for Intensive Care Patients (GRIP) incorporates the derivate aspect of PID controls by using not only the glucose levels and insulin rates, but the change in those values over time. 40,41 Taking into account the rate of change increases the effectiveness of GRIP, even during rapid changes in dextrose administration.…”

Section: Introductionmentioning

confidence: 99%

The Future is Now: Software-Guided Intensive Insulin Therapy in the Critically Ill

Rattan

Nasraway

2013

J Diabetes Sci Technol

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“…We used the same rules as used in the adult ICU. 16,32 We compared patients who received IV insulin therapy by unaided clinician titration (clinician titration) with those managed with eProtocol-insulin (eProtocolinsulin) to evaluate safety and feasibility of this CDS tool in the PICU.…”

mentioning

confidence: 99%

“…[11][12][13] In the adult intensive care unit (ICU), the use of computer clinical decision support (CDS) for BG control results in more consistent BG target levels and fewer adverse events than do paper protocols. [14][15][16] To optimize BG control, investigators have implemented bedside paper protocols or guidelines for intravenous insulin titration in the pediatric ICU (PICU). [17][18][19] However, CDS protocol use in the PICU is not widely accepted.…”

mentioning

confidence: 99%

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A Pediatric Intensive Care Unit Bedside Computer Clinical Decision Support Protocol for Hyperglycemia Is Feasible, Safe and Offers Advantages

Lanspa

Wilson

Sward

et al. 2017

Diabetes Technology & Therapeutics

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Background: Computer clinical decision support (CDS) systems are uncommon in the pediatric intensive care unit (PICU), despite evidence suggesting they improve outcomes in adult ICUs. We reasoned that a bedside CDS protocol for intravenous insulin titration, eProtocol-insulin, would be feasible and safe in critically ill children. Methods: We retrospectively reviewed data from non-diabetic children admitted to the PICU with blood glucose (BG) ‡140 mg/dL who were managed with intravenous insulin by either unaided clinician titration or eProtocol-insulin. Primary outcomes were BG measurements in target range (80-110 mg/dL) and severe hypoglycemia (BG £40 mg/dL); secondary outcomes were 60-day mortality and PICU length of stay. We assessed bedside nurse satisfaction with the eProtocol-insulin protocol by using a 5-point Likert scale and measured clinician compliance with eProtocol-insulin recommendations. Results: Over 5 years, 69 children were titrated with eProtocol-insulin versus 104 by unaided clinicians. eProtocol-insulin achieved target range more frequently than clinician titration (41% vs. 32%, P < 0.001). Severe hypoglycemia was uncommon in both groups (4.3% of patients in eProtocol-insulin, 8.7% in clinician titration, P = 0.37). There were no differences in mean time to BG target or median BG between the groups. Mortality was 23% in both groups. Clinician compliance with eProtocol-insulin recommendations was 89%. Nurses believed that eProtocol-insulin was easy to understand and safer than clinician titration. Conclusions: eProtocol-insulin is safe for titration of intravenous insulin in critically ill children. Clinical research protocols and quality improvement initiatives aimed at optimizing BG control should utilize detailed computer protocols that enable replicable clinician decisions.

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Multicenter Validation of a Computer-Based Clinical Decision Support Tool for Glucose Control in Adult and Pediatric Intensive Care Units

Abstract: A multicenter validation demonstrated that eProtocol-insulin is a valid, exportable tool that can assist clinicians in achieving control of glucose in critically ill adults and children.

Cited by 45 publications

References 21 publications

Computerized decision support in adult and pediatric critical care

Computerized decision support in adult and pediatric critical care

The Future is Now: Software-Guided Intensive Insulin Therapy in the Critically Ill

A Pediatric Intensive Care Unit Bedside Computer Clinical Decision Support Protocol for Hyperglycemia Is Feasible, Safe and Offers Advantages

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