Hains Isla M, Creswick Nerida, Westbrook Johanna I
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Stud Health Technol Inform. 2011;169:397-401.
Picture Archiving and Communication Systems (PACS) allow the fast delivery of imaging studies to clinicians at the point-of-care, supporting quicker decision-making. PACS has the potential to have a significant impact in the Intensive Care Unit (ICU) where critical decisions are made on a daily basis, particularly during ward rounds. We aimed to examine how accessing image information is integrated into ward rounds and if the presence of PACS produced innovations in ward round practices. We observed ward rounds and conducted interviews with ICU doctors at three hospitals with differing levels of PACS availability and computerization. Imaging results were infrequently viewed by clinicians during ward rounds in two ICUs: one without PACS and one which had both PACS and bedside computers. In the third ICU, where PACS was only available at a central workstation, images were frequently viewed throughout the daily round and integrated into decisions about patient care. The presence of bedside computers does not automatically result in innovations to work practice. Despite the ability to utilize PACS at the bedside to support decision-making, use was varied. Research to understand how the complexities and context of the ICU contribute to work practice innovation and why practice changes differ is required.
图像存档与通信系统（PACS）能够在护理点将影像学检查结果快速提供给临床医生，有助于更快地做出决策。PACS在重症监护病房（ICU）可能会产生重大影响，因为在ICU中，每天都要做出关键决策，尤其是在查房期间。我们旨在研究如何将获取图像信息融入查房过程，以及PACS的存在是否会在查房实践中产生创新。我们观察了查房情况，并对三家PACS可用性和计算机化程度不同的医院的ICU医生进行了访谈。在两个ICU中，临床医生在查房时很少查看影像学结果：一个没有PACS，另一个既有PACS又有床边计算机。在第三个ICU中，PACS仅在中央工作站可用，在每日查房过程中经常查看图像并将其纳入患者护理决策。床边计算机的存在并不会自动带来工作实践的创新。尽管能够在床边使用PACS来支持决策，但使用情况各不相同。需要开展研究来了解ICU的复杂性和背景如何促进工作实践创新，以及为什么实践变化存在差异。
