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  • 1
    Electronic Resource
    Electronic Resource
    Ergonomics applied to anaesthesia record keeping (1993)
    Springer
    Journal of clinical monitoring and computing 10 (1993), S. 251-259 
    Details
    ISSN: 1573-2614
    Keywords: anaesthesia ; anaesthesia record ; ergonomics ; information management ; medical informatics ; medical record
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract For almost 100 years, the anaesthesia record has been the sole information tool trying to fulfill an ample catalogue of functions related to the anaesthesia information processes. Automated anaesthetic record systems have evolved around data being available online, as an imitation of the handwritten record. None has developed an information tool capable of an efficient utilization of the wide range of resources provided by modern technology to fulfill the information requirements of the anaesthetic environment. We used a system ergonomic analysis trying to find the best solutions. As a result of it we drafted an Anaesthesia Information Concept (AIC) in which the complexity of data & information (D&I) processes is broken down to modules called Clinical Information Process Units (CIPUs). A CIPU is mainly defined by the responsibility of a staff member and focuses on the basic system patient, staff and machine (all devices). The internal functions of a CIPU are treatment control and medicolegal documentation. The external functions are fulfilled by transferring required sets of D&I for subsequent treatment control (next CIPU), audit, quality control, cost calculation, etc. Using such an approach, an Anaesthesia Information Concept (AIC) can be realized by a wide range of modular and hybrid systems (combination of different tools such as paper records, computers, etc.) as opposed to universal and single automated documentation systems, which up to now have failed to fulfill the information demands of the anaesthetic environment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01133016
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  • 2
    Electronic Resource
    Electronic Resource
    Decision making in high dependency environments — can we learn from modern industrial management models? (1994)
    Springer
    Journal of clinical monitoring and computing 11 (1994), S. 11-17 
    Details
    ISSN: 1573-2614
    Keywords: management ; High Dependency Environment ; Critical Care ; strategy ; patient management ; cybernetics ; artificial intelligence ; clinical decision making ; expert systems
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Increasing complexity and increased restraints affect the task of patient management in High Dependency Environments, which has become intricate and difficult. Medical knowledge alone is not enough any longer for proper patient care. Management ability and facilities are required. Current medical knowledge should be expanded by management methods and techniques. By looking at management models in the industry, we found striking similarities between the industrial management situation and clinical patient management. Both systems share complexity in structure, complexity in interaction and evolutionary character. Clinical patient management can be compared with a navigation process. The patient is steered by a control system, and course information is given by control dimensions. Clinical patient management becomes a succession of steering activities influenced by the surrounding systems. This system can be structured in three interacting layers: an operational level, in which information is collected and actions executed; a strategic level in which strategies based on goal-oriented mental anticipation of a probabilistic system are formulated; and a normative level at which principles and norms are defined. It is possible then, to define the tools which have to be developed and implemented to improve clinical management capabilities. At the operational level these tools are addresed to improve clinical decision making by providing information in an ergonomical way. They include artifact elimination, data reduction, increase in meaningful information and unwanted data filtering. At the strategic level, tools to check the feasibility of the applied strategies have to be developed, such as: ideal patient course plots and increased training in strategic thinking. At the normative level, strategic management capabilities can be improved by compiling, processing and providing clinical context sensitive norms, to set up boundares for strategies formulation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01132839
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  • 3
    Electronic Resource
    Electronic Resource
    Lessons learned while building an integrated ICU workstation (1994)
    Springer
    Journal of clinical monitoring and computing 11 (1994), S. 89-97 
    Details
    ISSN: 1573-2614
    Keywords: integrated intensive care workplace ; integrated displays cost-benefit-assessment ; electrical safety
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract The project LUCY (Linked Ulm Care sYstem) is described. The goal of this project was to build a research workstation in an Intensive Care Unit which enables evaluation of data/information processing and presentation concepts. Also evaluation of new devices and functions considering not only one device but the workplace as an entirety was an aim of the project. We describe the complete process of building from the stage of design until its testing in clinical routine. LUCY includes a patient monitor, a ventilator, 4 infusion pumps and 8 syringe pumps. All devices are connected to a preprocessing computer via serial interfaces. A high performance graphic workstation is used for central display of physiological and therapeutic variables. A versatile user interface provides touch screen, keyboard and mouse interaction. For fluid administration a bar code based control and documentation facility was included. While our scheduled development efforts were below 4 man-years, the overall man-power needed until the first routine test amounts to 8 man-years. Costs of devices and software sum up to 160,000 US$. First experiences in clinical routine show good general acceptance of the workplace concept. Analysing the recorded data we found 90% of the items to be redundant: individual filtering algorthms are necessary for each of nowaday's devices. The flexibility of the system concerning the implementation of new features is far from our expectations. Technical maintenance of the system during clinical operation requires continuous effort which we cannot afford in the current situation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01259558
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  • 4
    Electronic Resource
    Electronic Resource
    Information transfer in high dependency environments: An ergonomic analysis (1994)
    Springer
    Journal of clinical monitoring and computing 11 (1994), S. 105-115 
    Details
    ISSN: 1573-2614
    Keywords: anaesthesia ; critical care ; clinical information systems ; data management ; information ; intensive care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract We have studied the information flow in HDE (with special focus on the information transfer process) using data provided by a group of experienced health care professionals. A model of the information flow in HDE was built up. It postulates the existence of quanta of information (due to the artificial fragmentation of the information flow produced by the clinical working processes: organization in shifts, demand of simultaneous activities from different staff members, etc.). This fragmentation is described by using the so-called Clinical Information Process Units (CIPUs), which correspond to patient care activities going on in parallely and serially linked blocks, performed by the staff in the specific environments. Due to a transfer in responsibility over the patient the CIPUs are linked by information transfer events which are described using transfer modules (TraMs). We exemplified 32 CIPUs related to the clinical environments (PreOp, Surgery, Recovery Intensive Care, Ward, Diagnostics, Outpatient) and the health care professional groups (Anesthesiologist/Intensivist, Surgeon, Nurse, Physician, Diagnostic Physician, Physical Therapist). A matrix was established providing the transfer situations among the CIPUs enabling a systematic classification of the TraMs. The contents of the TraMs are built up of information link elements, which are assembled according to the specific settings of the transfer situation given by the emitter, receiver and purpose. In summary we modelled the process of information transfer in HDE through CIPUs, TraMs and information links in a way, which may be useful to design information technology applications or to reorganize the information management in HDE.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01259560
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  • 5
    Electronic Resource
    Electronic Resource
    Patient-related data management (1992)
    Springer
    Journal of clinical monitoring and computing 8 (1992), S. 308-314 
    Details
    ISSN: 1573-2614
    Keywords: Records: anesthesia ; Equipment: computers
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Patient-related data management (PDM) has become an increasingly important and time-consuming task in intensive care medicine. Currently, all data are usually collected in a poorly structured patient chart consisting of forms and pictures, with about 400 manual entries a day. To handle this amount of data, we have designed a three-level patient system: level 1, summarizing the whole patient; level 2, summarizing one organ system or one isolated problem; and level 3, variables describing morphology and function of organ systems. PDM must be adapted to different clinical situations. We observed three different scenarios: (1) Exploratory PDM, where the clinician learns about the patient and builds up an individual patient model in his or her mind. (2) Operational PDM, where in routine care clinicians are part of a feedback control system, in which they use the patient-related model. (3) Summary PDM, where a clinician summarizes all the information gathered during a period when he or she was responsible for the patient. Computing tools based on clinical thinking and adapted to different situations can ensure accurate, clear, and concise patient care communication among the members of the intensive care staff.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01617913
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  • 6
    Electronic Resource
    Electronic Resource
    Data quality of bedside monitoring in an intensive care unit (1994)
    Springer
    Journal of clinical monitoring and computing 11 (1994), S. 123-128 
    Details
    ISSN: 1573-2614
    Keywords: monitoring ; computing ; artefacts ; documentation ; ICU ; data management
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Computerized record keeping promises complete, accurate and legible documentation. Reliable measurements are a prerequisite to fulfill these expectations. We analyzed the physiological variables provided by bedside monitoring devices in 657 bedside visits performed by an experienced Intensive Care nurse during 75 Intensive Care rounds. We registered which variables were displayed. If a variable was displayed, we assessed whether it could be used for documentation or should be rejected. If a value was rejected the reason was registered as: the measurement was not intended (superfluous display), the current clinical situation did not allow proper measurement, or other reasons. Basic variables (vital signs and respiration related variables) were displayed in more then 90%, specific variables (e.g. intracranial pressure) were displayed in less than 50% of the situations. Displayed variables were superfluous on an average of 11% because measurement was not intended. Variables like heart rate, temperature, airway pressure, minute volume of ventilation, arrhythmia, pulmonary arterial pressure, non-invasive blood pressure, and intracranial pressure provide high quality measured values (acceptance of more than 90%). Invasive arterial pressure, central venous pressure, respiration rate and oxygen saturation (via pulse oximetry) provided lower quality values with a rejection rate higher than 10%. Inappropriate sensor technology to match the clinical environment seems to be the root cause. In future the request for automatic documentation will increase. In order to avoid additional staff workload and to ensure reliable documentation, sensor technology especially related to respiration rate, blood pressure measurements, and pulse oximetry should be improved.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01259562
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  • 7
    Electronic Resource
    Electronic Resource
    Postoperative information transfer: a study comparing two university hospitals (1994)
    Springer
    Journal of clinical monitoring and computing 11 (1994), S. 145-149 
    Details
    ISSN: 1573-2614
    Keywords: anesthesia ; records ; human factors ; information
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Several studies have addressed the processing of anesthetic information by paper anesthetic data records or by the electronic storage and transfer of anesthetic data. Our purpose was to analyze the oral transfer of information in the postoperative period. We investigated 198 post-operative transfer situations with 120 patients in a U.S. hospital to compare the results with those of a former study in a German hospital. A great number of parameters were used in both hospitals, but there were remarkable differences. In the U.S. hospital numeric values of current vital functions, including oxygen saturation, were more common during information transfer, whereas in the German hospital the emphasis was on case history and chronic health status. The data from the U.S. hospital and those of the German hospital show that in spite of complete anesthetic records, a short (112.3±104 sec in the U.S. and 94.1±83.6 sec in Germany) oral information transfer is inevitable when the patient is transferred from the OR to the recovery room, and from the recovery room to the ward (122.7±61.4 sec in the U.S. and 88.0±73.0 in Germany). Softwave developpers of patient data management systems could learn from this study that in some situations it is necessary and possible to create a small set of data which will reflect the patients status quite well.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01132362
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