Bansal P, Aronsky D, Aronsky D, Talbert D, Miller R A
Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
Proc AMIA Symp. 2001:32-6.
To evaluate impact of a computer-based intervention on arterial blood gas (ABG) usage in an intensive care setting.
Retrospectively examined, via mixed group analysis, the effects of the intervention on ABG usage in the intensive care unit (ICU).
Included all clinicians who placed ABG orders in an ICU using the computerized physician order-entry system, as well as controls in non-order entry units.
Computer-based intervention presenting ordering clinician with patient s previous ABG values and limiting forward duration of tests ordered. Study spanned 12 weeks, 5 weeks pre-intervention and 7-weeks post-intervention. Of 8 ICUs, intervention implemented in 6, not implemented in 2. Data analyzed using the repeated measure ANOVA.
Physicians entered <40% ABG orders. 376 ABGs per week processed pre-intervention, 387 per week post. Results nonsignificant with a p= 0.09. Orders placed declined from 1039 per week, Jan 2000 to 662 per week, April 2001.
Study did not demonstrate significant change; limited power. Need longer study periods. Impact improved in the future by targeting physician users and tailoring intervention to specific work flow pattern of high utilization units.
评估基于计算机的干预措施对重症监护环境中动脉血气（ABG）使用情况的影响。
通过混合组分析回顾性研究干预措施对重症监护病房（ICU）中ABG使用情况的影响。
包括所有在ICU使用计算机化医师医嘱录入系统下达ABG医嘱的临床医生，以及非医嘱录入科室的对照组。
基于计算机的干预措施向开医嘱的临床医生展示患者先前的ABG值，并限制所开检查的前瞻性时长。研究为期12周，干预前5周，干预后7周。8个ICU中，6个实施了干预，2个未实施。数据采用重复测量方差分析。
医生下达的ABG医嘱<40%。干预前每周处理376次ABG检查，干预后每周387次。结果无统计学意义，p = 0.09。2000年1月每周下达的医嘱从1039条降至2001年4月每周662条。
研究未显示出显著变化；效能有限。需要更长的研究周期。未来通过针对医生用户并根据高使用量科室的特定工作流程模式调整干预措施来改善影响。
