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

23 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

Fingerprint

Data Display
Physiologic Monitoring
Intensive Care Units
Randomized Controlled Trials
Parents
Neonatal Intensive Care
Doppler Ultrasonography
Pregnancy
Neonatal Intensive Care Units
Colloids
Critical Care
Random Allocation
Anxiety
Gases
Outcome Assessment (Health Care)
Oxygen
Technology
Education
Surveys and Questionnaires
Research

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

Cite this

Cunningham, Steven ; Deere, Sarah ; Symon, Andrew ; Elton, Robert A. ; McIntosh, Neil. / A randomized, controlled trial of computerized physiologic trend monitoring in an intensive care unit. In: Critical Care Medicine. 1998 ; Vol. 26, No. 12. pp. 2053-2060.
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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.",
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A randomized, controlled trial of computerized physiologic trend monitoring in an intensive care unit. / Cunningham, Steven; Deere, Sarah; Symon, Andrew; Elton, Robert A.; McIntosh, Neil.

In: Critical Care Medicine, Vol. 26, No. 12, 01.12.1998, p. 2053-2060.

Research output: Contribution to journalArticle

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N2 - 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.

AB - 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.

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