Havel Camille, Selim Jean, Besnier Emmanuel, Gouin Philippe, Veber Benoit, Clavier Thomas
Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France.
Normandie Univ, UNIROUEN, INSERM U1096, Rouen, France.
JMIR Perioper Med. 2019 Sep 4;2(2):e14501. doi: 10.2196/14501.
The implementation of computerized monitoring and prescription systems in intensive care has proven to be reliable in reducing the rate of medical error and increasing patient care time. They also showed a benefit in reducing the length of stay in the intensive care unit (ICU). However, this benefit has been poorly studied, with conflicting results.
This study aimed to show the impact of computerization on the length of stay in ICUs.
This was a before-after retrospective observational study. All patients admitted in the surgical ICU at the Rouen University Hospital were included, from June 1, 2015, to June 1, 2016, for the before period and from August 1, 2016, to August 1, 2017, for the after period. The data were extracted from the hospitalization report and included the following: epidemiological data (age, sex, weight, height, and body mass index), reason for ICU admission, severity score at admission, length of stay and mortality in ICU, mortality in hospital, use of life support during the stay, and ICU readmission during the same hospital stay. The consumption of antibiotics, biological analyses, and the number of chest x-rays during the stay were also analyzed.
A total of 1600 patients were included: 839 in the before period and 761 in the after period. Only the severity score Simplified Acute Physiology Score II was significantly higher in the postcomputerization period (38 [SD 20] vs 40 [SD 21]; P<.05). There was no significant difference in terms of length of stay in ICU, mortality, or readmission during the stay. There was a significant increase in the volume of prescribed biological analyses (5416 [5192-5956] biological exams prescribed in the period before Intellispace Critical Care and Anesthesia [ICCA] vs 6374 [6013-6986] biological exams prescribed in the period after ICCA; P=.002), with an increase in the total cost of biological analyses, to the detriment of hematological and biochemical blood tests. There was also a trend toward reduction in the average number of chest x-rays, but this was not significant (0.55 [SD 0.39] chest x-rays per day per patient before computerization vs 0.51 [SD 0.37] chest x-rays per day per patient after computerization; P=.05). On the other hand, there was a decrease in antibiotic prescribing in terms of cost per patient after the implementation of computerization (€149.50 [$164 USD] per patient before computerization vs €105.40 [$155 USD] per patient after computerization).
Implementation of an intensive care information system at the Rouen University Hospital in June 2016 did not have an impact on reducing the length of stay.
在重症监护中实施计算机化监测和处方系统已被证明在降低医疗差错率和增加患者护理时间方面是可靠的。它们还显示出在缩短重症监护病房（ICU）住院时间方面有好处。然而，这一益处的研究较少，结果相互矛盾。
本研究旨在表明计算机化对ICU住院时间的影响。
这是一项前后回顾性观察研究。纳入了鲁昂大学医院外科ICU在2015年6月1日至2016年6月1日（前期）以及2016年8月1日至2017年8月1日（后期）收治的所有患者。数据从住院报告中提取，包括以下内容：流行病学数据（年龄、性别、体重、身高和体重指数）、ICU入院原因、入院时的严重程度评分、ICU住院时间和死亡率、医院死亡率、住院期间生命支持的使用情况以及同一住院期间的ICU再入院情况。还分析了住院期间抗生素的使用、生物学分析以及胸部X光检查的次数。
共纳入1600例患者：前期839例，后期761例。仅在计算机化后时期，简化急性生理学评分II的严重程度评分显著更高（38[标准差20]对40[标准差21]；P<.05）。在ICU住院时间、死亡率或住院期间再入院方面没有显著差异。规定的生物学分析量显著增加（在Intellispace重症监护与麻醉[ICCA]之前的时期开具5416[5192 - 5956]次生物学检查，在ICCA之后的时期开具6374[6013 - 6986]次生物学检查；P =.002），生物学分析的总成本增加，血液学和生化血液检查受到影响。胸部X光检查的平均次数也有减少趋势，但不显著（计算机化前每位患者每天0.55[标准差0.39]次胸部X光检查，计算机化后每位患者每天0.51[标准差0.37]次胸部X光检查；P =.05）。另一方面，计算机化实施后每位患者的抗生素处方成本有所下降（计算机化前每位患者149.50欧元[164美元]，计算机化后每位患者105.40欧元[155美元]）。
2016年6月鲁昂大学医院实施重症监护信息系统对缩短住院时间没有影响。
