JMIR Publications

ABSTRACT

Background:

Clinicians working in intensive care units (ICUs) are immersed within a cacophony of alarms and a relentless onslaught of data. Within this frenetic environment, clinicians make high-stakes decisions using many data sources and are often over-saturated with information of varying quality. Traditional bedside monitors only depict static vital signs (VS) data, and these data are not easily viewable remotely. Clinicians must rely on separate nursing charts--hand-written or electric--to review physiological patterns, including signs of potential clinical deterioration. An automated physiological data viewer has been developed to provide at-a-glance summaries and to assist with prioritizing care for multiple critically ill patients.

Objective:

This study aims to evaluate a novel vital signs viewer system in a level 1 trauma center by subjectively assessing the viewer’s utility in a high-volume ICU setting.

Methods:

ICU attendings were surveyed during morning rounds. Physicians were asked to conduct rounds normally, using data reported from nurse charts and briefs from fellows to inform their clinical decisions. After the physician finished their assessment and plan for the patient, they were asked to complete a questionnaire. Following completion of the questionnaire, the viewer was presented to ICU physicians on a tablet personal computer (PC) that displayed the patient’s physiologic data (i.e., shock index, blood pressure, heart rate, temperature, respiratory rate, pulse oximetry), summarized up to 72 hours. After examining the viewer, ICU physicians completed a post-view questionnaire. In both questionnaires, the physicians were asked questions regarding the patient’s stability, status, and need for a higher or lower level of care. A hierarchical clustering analysis was used to group participating ICU physicians and to assess their general reception of the viewer.

Results:

A total of 908 surveys were collected from 28 ICU physicians from February 2015 to June 2017. Regarding physicians’ perception of whether the viewer significantly enhanced the ability to assess multiple ICU patients, 5.0% strongly agreed, 56.6% agreed, 35.3% were neutral, 2.9% disagreed, and 0.2% strongly disagreed.

Conclusions:

Morning rounds in a trauma center ICU are conducted in a busy environment with many data sources. This study demonstrates that organized physiologic data and visual assessment can improve situation awareness, assist clinicians with recognizing changes in patient status and prioritize care.