Computer management systems and protocols in intensive care units: do we have any benefit?
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KeywordsTreatment Protocol Data Management System Medline Search Absolute Reduction Improve Patient Safety
Computer management systems and treatment protocols (CMS/P) have been recommended for their potential to improve patient safety and outcome. Computer management systems require substantial investments in the ICUs. In return, a high-quality, standardised ICU treatment with software-implemented protocols as well as decreased hand-written documentation has been aimed at. The objective of this study was to systematically review the literature on CMS/P to evaluate their impact on outcome benefit.
A Medline search from 1996 to 2006 with the following key words was performed: critical care or intensive care, and protocol, and data management system or computer management system or computerized documentation.
The search revealed 21 potential articles. The language was English in 18 of the articles, two in German and one in Japanese. Of those 21, 10 articles were not studying CMS/P. Of those 11 that fulfilled the criteria, computer management systems were studied in four articles and treatment protocols in 11 articles. The combination of ICU treatment protocol and computer management system was studied in four of the 21 articles.
Of those 11, three of the studies demonstrated that the implementation of a protocol to computer management system increases staff compliance to the protocol. The newer studies showed also that the costs were not increased by the computerised protocol. However, no definite benefit in patient survival or ICU length of stay could be demonstrated (11 of 21 studies). The combined absolute reduction rate in hospital mortality was 2% (95% CI 0–4%) in those four (19% of 21) studies. CMS/P increased the ICU length of stay 3.5 days (95% CI 1.6–5.4 days) and decreased the hospital length of stay 5.9 days (95% CI 1.0–10.8 days), in two different studies.
Our results could not confirm any definite benefit from computerised data management systems or treatment protocols regarding outcome. The ICU personnel adherence to treatment protocols seems to increase when implemented into the computerised data management systems. Further research on this topic is needed to justify the investments in computer management systems.