Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, Minnesota, United States.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States.
Appl Clin Inform. 2024 May;15(3):414-427. doi: 10.1055/a-2299-7643. Epub 2024 Apr 4.
Intensive care unit (ICU) clinicians encounter frequent challenges with managing vast amounts of fragmented data while caring for multiple critically ill patients simultaneously. This may lead to increased provider cognitive load that may jeopardize patient safety.
This systematic review assesses the impact of centralized multipatient dashboards on ICU clinician performance, perceptions regarding the use of these tools, and patient outcomes.
A literature search was conducted on February 9, 2023, using the EBSCO CINAHL, Cochrane Central Register of Controlled Trials, Embase, IEEE Xplore, MEDLINE, Scopus, and Web of Science Core Collection databases. Eligible studies that included ICU clinicians as participants and tested the effect of dashboards designed for use by multiple users to manage multiple patients on user performance and/or satisfaction compared with the standard practice. We narratively synthesized eligible studies following the SWiM (Synthesis Without Meta-analysis) guidelines. Studies were grouped based on dashboard type and outcomes assessed.
The search yielded a total of 2,407 studies. Five studies met inclusion criteria and were included. Among these, three studies evaluated interactive displays in the ICU, one study assessed two dashboards in the pediatric ICU (PICU), and one study examined centralized monitor in the PICU. Most studies reported several positive outcomes, including reductions in data gathering time before rounds, a decrease in misrepresentations during multidisciplinary rounds, improved daily documentation compliance, faster decision-making, and user satisfaction. One study did not report any significant association.
The multipatient dashboards were associated with improved ICU clinician performance and were positively perceived in most of the included studies. The risk of bias was high, and the certainty of evidence was very low, due to inconsistencies, imprecision, indirectness in the outcome measure, and methodological limitations. Designing and evaluating multipatient tools using robust research methodologies is an important focus for future research.
重症监护病房(ICU)的临床医生在同时照顾多名危重病患者时,经常会遇到管理大量碎片化数据的挑战。这可能会导致提供者认知负荷增加,从而危及患者安全。
本系统评价评估了集中式多患者仪表盘对 ICU 临床医生的绩效、对这些工具使用的看法以及患者结局的影响。
于 2023 年 2 月 9 日,使用 EBSCO CINAHL、Cochrane 对照试验中心注册库、Embase、IEEE Xplore、MEDLINE、Scopus 和 Web of Science 核心合集数据库进行文献检索。纳入的研究包括 ICU 临床医生作为参与者,并测试了为多名用户设计用于管理多名患者的仪表盘对用户绩效和/或满意度的影响,与标准实践进行比较。我们按照 SWiM(无荟萃分析的综合)指南对符合条件的研究进行了叙述性综合。研究根据仪表盘类型和评估的结果进行分组。
检索共产生了 2407 项研究。有 5 项研究符合纳入标准并被纳入。其中,3 项研究评估了 ICU 中的交互式显示器,1 项研究评估了儿科 ICU(PICU)中的 2 个仪表盘,1 项研究检查了 PICU 中的集中式监测器。大多数研究报告了几个积极的结果,包括在查房前减少数据收集时间,在多学科查房期间减少错误陈述,提高日常文件记录合规性,更快的决策制定和用户满意度。有 1 项研究没有报告任何显著关联。
多患者仪表盘与 ICU 临床医生的绩效提高有关,并且在大多数纳入的研究中得到了积极的评价。由于结果衡量标准的不一致性、不精确性、间接性以及方法学上的限制,偏倚风险高,证据确定性极低。使用稳健的研究方法设计和评估多患者工具是未来研究的一个重要重点。