A randomized, controlled trial of computerized physiologic trend monitoring in an intensive care unit

Steven Cunningham, Sarah Deere, Andrew Symon, Robert A. Elton, Neil McIntosh

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objective: To assess whether the provision of computerized physiologic trend data could improve outcome in newborn infants requiring intensive care. 

Design: Randomized, controlled trial, with subsidiary questionnaire studies. 

Setting: Tertiary neonatal intensive care unit with 12 intensive care cots. 

Patients: All infants admitted between January 1991 and September 1993 who were ≤32 wks gestation or >32 wks gestation, and ventilated for >4 hrs or asphyxiated. 

Interventions: Randomization to one of four groups for first 7 days of life: A) no display of trend data; B) continuous display of trend data; C1) alternating 24-hr display of trend data, starting with display in first 24 hrs; and C2) alternating 24-hr display of trend data, starting with no display in first 24 hrs. 

Measurements and Main Results: The short-term effects of monitoring on patient outcome was judged by volume of colloid given, number of blood gases taken, and by measurement taken from cranial Doppler ultrasound. Medium-term measures included time ventilated, time given supplemental oxygen, death, time to death or discharge, and cranial ultrasound at discharge. Long-term outcome was assessed by neurodevelopmental status at age 1 to 4 yrs of age. Staff and parent questionnaires assessed their respective attitudes to the introduction of this technology. None of the patient outcome measures, short-, medium-, or long-term, demonstrated any significant benefit from the provision of computerized physiologic trend monitoring. Staff questionnaires demonstrated an acceptance of the system and an improved understanding of neonatal physiology as a result of computerized physiologic trends. Parent questionnaires demonstrated increased anxiety caused by the system in 11% of parents, although only 1% of parents continued to have concerns if the system were able to help their child. 

Conclusions: A randomized, controlled trial was unable to demonstrate any benefit to patients resulting from the introduction of a computerized physiologic trend monitoring system. Benefits of the system have been recognized, however, in subsidiary studies, staff education, and research studies.

Original languageEnglish
Pages (from-to)2053-2060
Number of pages8
JournalCritical Care Medicine
Volume26
Issue number12
DOIs
Publication statusPublished - 1 Dec 1998

Keywords

  • Computer systems
  • Computer systems, evaluation
  • Computers
  • Decision support systems
  • Infant, low birth weight
  • Infant, newborn
  • Infant, newborn diseases
  • Infant, premature
  • Intensive care
  • Intensive care, neonatal
  • Nurse-patient relations
  • Patient satisfaction

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