Study casts doubt on some high-tech ICU investments

Is state-of-the-art technology for the ICU worth the investment regardless of the price tag? A group of clinical researchers hypothesized that it would indeed be worth the expense. They based their belief on the theory that computerized technology would result in better clinical outcomes, which would justify a hefty financial investment.

But when they tested the theory, the research team from the University of Edinburgh in Edinburgh, UK, found that the presence of at least one type of technology, which half of all ICUs have expressed interest in, had hardly any effect on improving patient outcomes.

Some 50% of ICUs in the United States are reportedly eyeing the potential of investing in online physiologic trend monitoring, a highly convenient but expensive computerized monitoring system that provides real-time, continually updated trends on physiologic patient data.

Computer monitors physiologic indicators

The data is displayed on a computer screen and provides ongoing trend data based on readings of major physiologic indicators such as a patient’s heart and respiratory rate, blood pressure, and chest drain levels at one time. The readings are displayed in graphical form and run horizontally across the computer screen in a manner similar to an electrocardiogram readout tape.

The system could alert a medical staff to sudden changes in the patient’s physiological condition earlier than the conventional, regularly updated display of individual physiologic values presented in tabular or spreadsheet form, according to a study in Critical Care Medicine.1

But a randomized, controlled trial of the system was unable to show "any benefit to patients from the introduction of the computerized" trend monitoring.

The results led Jon N. Meliones, MD, an intensivist at Duke University Medical Center in Durham, NC, to conclude that physiologic "data presented in this manner does not significantly add to the daily management of patients."2 The study was conducted in a neonatal ICU.

One possible reason given by Meliones is that ICU personnel generally interpret and assimilate trend data as they occur regardless of whether the data are presented in computerized or tabular versions.

The findings raise questions about the cost and benefits of adding some forms of expensive new technology to the ICU. "The cost/benefit ratio of adding new technology must be accurately assessed before we purchase these expensive products," Meliones says.2

References

1. Cunningham S, Deere S, Symon A, et al. A randomized, controlled trial of computerized physiologic trend monitoring in an intensive care unit. Crit Care Med 1998; 26:2,053-2,059.

2. Meliones JN. To monitor or not to monitor. Crit Care Med 1998; 26:1,951.