Best Practice & Research Clinical Anaesthesiology
Volume 23, Issue 1 , Pages 51-67, March 2009

Computer protocols: how to implement☆

  • A.H. Morris, MD (Professor of Medicine, Adjunct Professor of Biomedical Informatics)

      Affiliations

    • Pulmonary and Critical Care Divisions, Departments of Medicine, LDS Hospital, Intermountain Medical Center, University of Utah School of Medicine, Salt Lake City, UT, USA
    • Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA
    • Corresponding Author InformationCorresponding author. Pulmonary/Critical Care Division, Sorenson Heart-Lung Center, 6th Floor, Intermountain Medical Center, 1521 South Cottonwood Street, Murray, UT 84157-7000, USA. Tel.: +1 801 507 4603, +1 801 718 1283 (Mobile); Fax: +1 801 507 4699.
    • ,
  • E. Hirshberg, MD (Assistant Professor of Medicine, Adjunct Assistant Professor of Pediatrics)

      Affiliations

    • Pulmonary and Critical Care Divisions, Departments of Medicine, LDS Hospital, Intermountain Medical Center, University of Utah School of Medicine, Salt Lake City, UT, USA
    • Department of Pediatrics, Primary Children's Medical Center, University of Utah School of Medicine, Salt Lake City, UT, USA
    • ,
  • K.A. Sward, RN, PhD (Assistant Professor of Nursing, Adjunct Assistant Professor of Biomedical Informatics)

      Affiliations

    • Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA
    • University of Utah College of Nursing, Salt Lake City, UT, USA

Variation in clinical practice impedes control, is associated with unwanted and widespread error, and may preclude replicability. Methodologic replicability enhances our ability to detect signals of interest by both increasing the signal through consistent application of the intervention, and by reducing the obscuring effects of noise. Decision-support tools are intended to standardize some aspect of clinical care and thereby help lead to uniform implementation of clinical interventions. This is realized by explicit replicable computer protocols that can produce appropriate patient-specific decisions and introduce control of process into clinical care. Development of such protocols has required around-the-clock implementation for patient management because of the influence of patient history and previous patient states on the output of the computer protocol. Three successful computer protocols for management of blood glucose provide compelling examples. This clinician driven “bottom-up” approach complements the common information technology service driven “top-down” approach to clinical problems.

Keywords: computer protocols, process, replicability, method, glucose, development, clinical, intensive care

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☆ Supported in part by the NIH (RO1-HL-36787, NO1-HR-46062), the AHCPR (HS 06594) the Deseret Foundation, the Respiratory Distress Syndrome Foundation, the LDS Hospital, the Deseret Foundation, and by Intermountain Healthcare, Inc.

PII: S1521-6896(08)00084-0

doi:10.1016/j.bpa.2008.09.002

Best Practice & Research Clinical Anaesthesiology
Volume 23, Issue 1 , Pages 51-67, March 2009

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