Abstract
We implemented a computerized decision support tool to standardize the administration of supplemental oxygen (O2) therapy in the acute care (non-ICU) hospital setting. Caregiver acceptance of the computerizeds oxygen therapy protocol (COTP) instructions was measured to determine the clinical performance of the computerized decision support tool. 49.6% of instructions generated were followed by the clinical caregiver, and 16.8% of instructions generated were explicitly acknowledged by the user through the COTP computer interface. Despite this low caregiver response rate, significant favorable changes in the administration of oxygen were observed. This paper is focused on the issues of general importance the caregiver response rate raises for the implementation and clinical use of computerized decision support tools, including: (1) limitations of the user interface and (2) inherent difficulty in changing long-standing practice patterns.
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Selected References
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- Albin R. J., Criner G. J., Thomas S., Abou-Jaoude S. Pattern of non-ICU inpatient supplemental oxygen utilization in a university hospital. Chest. 1992 Dec;102(6):1672–1675. doi: 10.1378/chest.102.6.1672. [DOI] [PubMed] [Google Scholar]
- Bowton D. L., Scuderi P. E., Harris L., Haponik E. F. Pulse oximetry monitoring outside the intensive care unit: progress or problem? Ann Intern Med. 1991 Sep 15;115(6):450–454. doi: 10.7326/0003-4819-115-6-450. [DOI] [PubMed] [Google Scholar]
- Cruickshank M. K., Levine M. N., Hirsh J., Roberts R., Siguenza M. A standard heparin nomogram for the management of heparin therapy. Arch Intern Med. 1991 Feb;151(2):333–337. [PubMed] [Google Scholar]
- Dawes R. M., Faust D., Meehl P. E. Clinical versus actuarial judgment. Science. 1989 Mar 31;243(4899):1668–1674. doi: 10.1126/science.2648573. [DOI] [PubMed] [Google Scholar]
- East T. D., Böhm S. H., Wallace C. J., Clemmer T. P., Weaver L. K., Orme J. F., Jr, Morris A. H. A successful computerized protocol for clinical management of pressure control inverse ratio ventilation in ARDS patients. Chest. 1992 Mar;101(3):697–710. doi: 10.1378/chest.101.3.697. [DOI] [PubMed] [Google Scholar]
- East T. D., Morris A. H., Wallace C. J., Clemmer T. P., Orme J. F., Jr, Weaver L. K., Henderson S., Sittig D. F. A strategy for development of computerized critical care decision support systems. Int J Clin Monit Comput. 1991;8(4):263–269. doi: 10.1007/BF01739127. [DOI] [PubMed] [Google Scholar]
- Evans R. S., Pestotnik S. L., Burke J. P., Gardner R. M., Larsen R. A., Classen D. C. Reducing the duration of prophylactic antibiotic use through computer monitoring of surgical patients. DICP. 1990 Apr;24(4):351–354. doi: 10.1177/106002809002400401. [DOI] [PubMed] [Google Scholar]
- Hull R. D., Raskob G. E., Rosenbloom D., Panju A. A., Brill-Edwards P., Ginsberg J. S., Hirsh J., Martin G. J., Green D. Heparin for 5 days as compared with 10 days in the initial treatment of proximal venous thrombosis. N Engl J Med. 1990 May 3;322(18):1260–1264. doi: 10.1056/NEJM199005033221802. [DOI] [PubMed] [Google Scholar]
- Zibrak J. D., Rossetti P., Wood E. Effect of reductions in respiratory therapy on patient outcome. N Engl J Med. 1986 Jul 31;315(5):292–295. doi: 10.1056/NEJM198607313150505. [DOI] [PubMed] [Google Scholar]
- Zibrak J. D., Sommerville J., O'Donnell C. Results of a prospective trial of strategies for improving oxygen utilization. Respir Care. 1987 Oct;32(10):859–864. [PubMed] [Google Scholar]