Intensive Care Med (2010) 36:1616–1617 DOI 10.1007/s00134-010-1932-3
CO RRESPONDENCE
‘‘paperless’’ by implementing an and audit; (e) user satisfaction measured on a Likert scale (1, very integrated CIS with charting, clinical satisfied; 5, very dissatisfied); and (f) documentation and prescribing funcfuture plans for CIS implementation. tions. In general, larger units were Data were analysed at the unit level, more likely to adopt more functional, except satisfaction scores, which were commercial systems rather than ‘‘home-grown’’ databases (p \ 0.05). analysed at the respondent level. Characteristics of participating units Clinical functionality provided by the (admission numbers, number of beds various PICU systems is summarised Survey of clinical information in Table 1. In addition to clinical and unit type) were obtained from system usage by paediatric systems, a number of separate PICANet. Group-wise differences intensive care units in the UK were analysed by using the chi-square research and audit databases were test; Wilcoxon sign rank test was used also used to store data on specific Accepted: 26 April 2010 patient groups (e.g. sepsis or extrafor satisfaction scores. Published online: 26 May 2010 corporeal membrane oxygenation) Fifty respondents from 28 out of 32 Ó Copyright jointly held by Springer and resulting in significant duplication of UK PICUs completed the survey ESICM 2010 (response rate 88%). Intensivists and data entry and storage. No significant On behalf of the UK Paediatric Intensive differences were seen between satisnurses comprised the majority of Care Society Informatics Study Group. subjects (62%). One-third of the units faction levels of doctors and nurses, although ‘‘home-grown’’, less funcadmitted more than 500 patients/ tional systems scored marginally year, the majority being combined higher satisfaction levels than commedical-surgical units. More than Dear Editor, 80% of the units used hospital-wide mercially procured systems (median The use of clinical information sys- systems for patient admission/dis2.5 vs. 2.0). Nevertheless, 5 PICUs tems (CIS) and electronic prescribing charge, radiology and laboratory reported plans to procure fully funchave been shown in single centre tional CIS within a year of the survey. results. In addition, units used a studies to improve access to vital Our study demonstrates poor mixture of small locally developed data, enhance patient safety and uptake of CIS in UK PICUs, with (16/28) and commercial databases reduce manual documentation time in (8/28) with widely varying clinical larger units more likely to invest in critical care [1, 2]. There are few functionality. Only one unit had gone clinical systems and smaller units large-scale reports of CIS utilisation in paediatric intensive care units Table 1 Clinical functionality provided by electronic systems to PICU users (n = 28) (PICU). As part of the Informatics subgroup of the UK Paediatric Clinical function Electronic Paper Intensive Care Society, we consystem (n) records (n) ducted a national survey to study the Medical documentation 5 22 distribution, characteristics and Nursing documentation 3 25 satisfaction with existing electronic Record of interventions/procedures 15 9 systems. Record of complications/adverse events 7 17 Lead intensivists, nurses and/or Data on external (retrieved) admissions 16 9 Diagnostic coding 28 – data managers from the Paediatric 9 Intensive Care Audit Network (PIC- ICD-10 SNOMED Clinical TermsÒ 0 ANet) [3] were invited to complete a Read Codes (Clinical Terms Version 3)a 15 self-administered questionnaire Australian and New Zealand Paediatric Intensive Care 2 codes (ANZPICC) survey in September 2007, either International Paediatric and Congenital Cardiac Codes 2 online (QuestionPro, http://www. (IPCCC) questionpro.com), on an emailed Physiological variables charting 3 25 portable document format (PDF) Medication administration record (MAR) 3 25 form or on paper. Questions focused Electronic prescribing and decision support 1 – on: (a) use of hospital-wide ICD-10 The International Statistical Classification of Diseases and Related Health Probelectronic systems; (b) clinical lems 10th Revision, SNOMED Systematised Nomenclature of Medicine Clinical Terms functionality available in PICU sys- a Read Codes are developed from and used extensively from UK general practice, and are tems; (c) data security; (d) research fully incorporated into the latest SNOMED Clinical Terms UK version Krish Thiru Stuart Rowe Nicola Shaw Andrew Durward David P. Inwald Padmanabhan Ramnarayan
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likely to either develop their own databases or rely on free software (e.g. PICANet) for administrative functions. Similar findings have been reported recently from adult critical care units in Ontario [4]. Future improvement in patient safety and delivery of evidence-based care are likely to be stifled without widespread adoption of CIS, particularly by smaller units [5]. Large-scale studies (ideally utilising a cluster-randomised or controlled before-after design) to provide robust evidence on the effect of CIS implementation on key patient outcomes are necessary to justify the significant investment required, especially at a time of financial constraints.
References 1. Levy MM (2004) Computers in the intensive care unit. J Crit Care 19:199– 200 2. Varon J, Marik PE (2002) Clinical information systems and the electronic medical record in the intensive care unit. Curr Opin Crit Care 8:616–624
3. The Paediatric Intensive Care Audit Network (PICANet) (2008) National report of the Paediatric Intensive Care Audit Network January 2005–December 2007. Available via PICANet. http://www.picanet.org.uk/. Accessed 25 Apr 2010 4. Lapinsky SE, Holt D, Hallett D, Abdolell M, Adhikari NK (2008) Survey of information technology in intensive care units in Ontario, Canada. BMC Med Inform Decis Mak 8:5 5. Bates DW, Gawande AA (2003) Improving safety with information technology. N Engl J Med 348:2526– 2534
N. Shaw Applied Social Research in Health Informatics (ASRHI), 3rd Floor Environmental Engineering Bldg, University of Alberta, Edmonton, AB T6G 2M8, Canada e-mail:
[email protected] A. Durward Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Trust, Westminster Bridge Road, London SE1 7EH, UK e-mail:
[email protected]
K. Thiru Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK e-mail:
[email protected]
D. P. Inwald Department of Paediatrics, Faculty of Medicine, Imperial College London, St Mary’s Campus, Norfolk Place, London W2 1PG, UK e-mail:
[email protected]
S. Rowe Hammersmith and Fulham Primary Care Trust, 5–7 Parsons Green, London SW6 4UL, UK e-mail:
[email protected]
P. Ramnarayan ()) Children’s Acute Transport Service, Great Ormond Street Hospital, London WC1R 4LL, UK e-mail:
[email protected]
