Intensive Care & Anesthesiology Department, Saint Eloi Hospital, University of Montpellier Hospital, Montpellier, France.
PLoS One. 2013 May 30;8(5):e63771. doi: 10.1371/journal.pone.0063771. Print 2013.
To assess the impact of a simple computer-based decision-support system (computer help) on the quality of nutrition support orders and patients' outcome in Intensive-Care Unit (ICU).
This quality-improvement study was carried out in a 16-bed medical-surgical ICU in a French university hospital. All consecutive patients who stayed in ICU more than 10 days with non-oral feeding for more than 5 days were retrospectively included during two 12-month periods. Prescriptions of nutrition support were collected and compared to French national guidelines as a quality-improvement process. A computer help was constructed using a simple Excel-sheet (Microsoft(TM)) to guide physicians' prescriptions according to guidelines. This computer help was displayed in computers previously used for medical orders. Physicians were informed but no systematic protocol was implemented. Patients included during the first (control group) and second period (computer help group) were compared for achievement of nutrition goals and ICU outcomes.
The control and computer help groups respectively included 71 and 95 patients. Patients' characteristics were not significantly different between groups. In the computer help group, prescriptions achieved significantly more often 80% of nutrition goals for calorie (45% vs. 79% p<0.001) and nitrogen intake (3% vs. 37%, p<0.001). Incidence of nosocomial infections decreased significantly between the two groups (59% vs. 41%, p = 0.03). Mortality did not significantly differ between control (21%) and computer help groups (15%, p = 0.30).
Use of a widespread inexpensive computer help is associated with significant improvements in nutrition support orders and decreased nosocomial infections in ICU patients. This computer-help is provided in electronic supplement.
评估基于计算机的简单决策支持系统（计算机帮助）对重症监护病房（ICU）中营养支持医嘱质量和患者预后的影响。
本质量改进研究在法国一所大学医院的 16 张病床的内科-外科 ICU 中进行。在两个 12 个月的时间段内，回顾性纳入所有在 ICU 停留超过 10 天且非口服喂养超过 5 天的连续患者。收集营养支持处方，并与法国国家指南进行比较，作为质量改进过程。使用简单的 Excel 工作表（Microsoft(TM)）构建计算机帮助，以根据指南指导医生的处方。该计算机帮助显示在之前用于医疗订单的计算机上。通知了医生，但没有实施系统协议。比较第一期（对照组）和第二期（计算机帮助组）患者实现营养目标和 ICU 结局的情况。
对照组和计算机帮助组分别纳入 71 例和 95 例患者。两组患者的特征无显著差异。在计算机帮助组中，处方达到营养目标的比例显著更高，热量（45% vs. 79%，p<0.001）和氮摄入（3% vs. 37%，p<0.001）分别达到 80%。两组医院感染发生率均显著降低（59% vs. 41%，p=0.03）。对照组（21%）和计算机帮助组（15%）的死亡率无显著差异（p=0.30）。
使用广泛且廉价的计算机帮助与营养支持医嘱的显著改善和 ICU 患者医院感染的减少相关。该计算机帮助以电子补充形式提供。
