Critical Care Plus

Don’t Let Your ICU Computer Bug You

Checking out system avoids health and financial costs

Computers installed to help streamline ICU procedures at Mclaren Regional Medical Center brought more infections in their wake. Mclaren ICU physician Gregory Forstall, MD, diagnosed a patient with Aspergillus fumigatus, an infection rarely found at the Flint, Mich, facility, shortly after the new electronics were installed.

The computers had vents with exhaust-producing cooling fans, Forstall reported at a recent meeting of the American Society for Microbiology. When he and his colleagues cultured dust samples taken from the computer vent and from room air about 6 ft away, they found several types of yeast and some filamentous mold. Forstall’s group identified isolates of Candida, Aspergillus niger, Phaeoannellomyces, Rhodotorula, and Rhizopus. They concluded that ICU infection-control measures should include routine cleaning of computer vents.

Is the Benefit Worth the Cost?

Mold and yeast may not be the only ICU computer problem. At least one study shows that spending scarce dollars on expensive state-of-the-art computerized equipment does little to improve ICU patient outcomes.1

More than half the ICUs in the United States are reportedly interested in acquiring physiologic trend-monitoring equipment, which provide real time data about the patient’s heart and respiratory rates, blood pressure, and chest drain levels by displaying continuously updated readings on a computer screen.1

However, a randomized controlled trial of the system was unable to show much patient benefit. A group of clinical researchers reported initially that the system could alert ICU staff to sudden changes in patient condition sooner than conventional systems. The research team established a working hypothesis that the system’s monitoring efficiency would more than justify its high cost. But when they tested this theory they found the system failed to ameliorate results.

Moreover, research done by Jon N. Meliones, MD, found that presenting data via physiologic trend systems "does not significantly add to the daily management of patients."2 Meliones, who heads the pediatric critical care staff at Duke University Medical Center in Durham, NC, says that ICU staff members constantly monitor and interpret patients vital data regardless of whether the information is presented in tabular or computerized form.

References

1. Cunningham S, et al. A randomized, controlled trial of computerized physiologic trend monitoring in an intensive care unit. Crit Care Med. 1998;26:2053-2059.

2. Meliones JN. To monitor or not to monitor. Crit Care Med. 1998;26:1951.