Performance Evaluation of Computerized Clinical Protocols for Management of Arterial Hypoxemia in ARDS Patients

Abstract

Protocols were created to direct the management of arterial hypoxemia in critically ill patients with adult respiratory distress syndrome (ARDS). The protocols used clinical information to generate suggestions for therapy. They were initially created on paper and then implemented on a computer. We measured how often the clinical staff followed protocol suggestions in 16 ARDS patients. We also compared computer generated suggestions with those from the paper protocols. The study included 5130 hours of patient care and 3553 computer generated suggestions. The clinical staff followed the protocol suggestions 76.9% of the time and compliance increased with time (63.9% compliance for the first 8 patients and 91.8% compliance with the last 8 patients). Differences between the paper and computer protocol versions were primarily due to software errors and inaccurate and untimely entry of data into the computer. Both software errors and data entry problems decreased with time but the data entry problems were more persistent (From the first 8 to the last 8 patients, software errors decreased from 7.2 to 0.8% while incomplete data base and data entry problems decreased from 6.8 to 4.5%). The major problem in creating the protocols was obtaining clinician agreement on protocol logic and their willingness to utilize it clinically around the clock. The major problem in implementing protocol directed care was obtaining accurate and timely data entry. We conclude that computerized protocols can direct the clinical care of critically ill patients in a manner that is acceptable to experienced clinicians.