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Our Journey Towards the Implementation of a Clinical Information System to the Critical Care Environment

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OUR JOURNEY TOWARDS THE IMPLEMENTATION OF A CLINICAL INFORMATION SYSTEM TO THE CRITICAL CARE ENVIRONMENT

INTRODUCTION

The delivery of health care has become increasingly complex, and most clinical research focuses on new approaches to diagnosis and treatment. There have been significant advances in medical technology used in patient treatment and care. The Intensive Care Unit (ICU) in an acute hospital is designed to treat the most complex and unstable medical and surgical patient. Most ICU admissions occur because the patient requires technology that is available only within the ICU for monitoring or therapeutic purposes (Scales et al, 2004) . In the past decade, the medical technology and systems used in Intensive Care Units have become significantly more sophisticated. A typical ICU would have immediate access to core technologies such as respiratory ventilators, physiological and cardiac monitoring, infusion/ management systems, and blood gas analysers. Additional equipment such as non-invasive ventilators, cardiac defribrillators, imaging systems and pathology services would also be routinely used in response to individual patient requirements. Teams of highly trained professionals use technology as an integral part of their work in the ICU. These include medical intensivists, critical care nurses, clinical pharmacists, physiotherapists, dieticians, medical and surgical specialties, and personnel from a range of supporting specialties such as Laboratory, and Radiology.

In the past decade, the risk of harm caused by medical care has received increasing scrutiny (Bates et al, 2003) . Almost every major industry has used advances in information technology to increase work productivity and improve safety. Similarly, the medical literature is increasingly supporting the view that the greatest improvements in patient care and safety are through approaches that allow best use of the medical data available, to perfect existing techniques of evaluation and care, rather than the introduction of new technologies alone. Breslow et al (2005) describe how Information Technology tools offer greater potential to enhance the quality and safety of patient care and increase provider effectiveness.

A Clinical Information System (CIS) is an example of such technology. A CIS was first defined by Morris (1988) as a means to integrate clinical information at the point-of-care. A CIS allows the capture of the entire patient generated clinical and physiological data, and present it in a form that makes it available as useful information. The real power of the CIS, which facilitates real patient benefits, is that it can become a clinical decision support tool that supports evidence based practice. There are many published examples on how such a methodology directs patient care through implementing patient treatment protocols, and managing all sources of patient data generated at the point of care (Gardner 1998) .

A major capital development programme commenced at the University College Hospital Galway in 2000, and included the provision of a state-of-the-art 27-bed critical care service, which includes a 12 bed General Medical and Surgical ICU. A project Team was formed, which included personnel from the ICU, to equip the unit with medical equipment. This included the installation of a CIS to the 12-bed ICU, with provision to expand the system to the 27-bed compliment of the critical care services at UCHG.

At the time of writing, the CIS has been in use for 5 months. This paper will explore the equipping process undertaken at UCHG; the initial proposal for funding, the tender evaluation process, and the implementation phase of the project. It will also give an account of the clinical experiences with the system, why the project was successful, and how the ICU plans to develop the system further and use it to help direct an evidence based approach to the care of the critically ill patient.

2. BACKGROUND

2.1 Critical Care Services at Galway Regional Hospitals

Critical care areas have, traditionally, been divided into ICU (Intensive care units), where the highest level of care is given to the sickest patients, and HDU (high dependency units), where an intermediate level of care is provided for those who are not well enough to go back to general wards. The combination of both these facilities are referred to as "critical care".

The critical care complex at Galway Regional Hospitals (GRH) is provided over two sites, based at University College Hospital Galway (UCHG), and Merlin Park Hospital (MPH).

UCHG has just completed construction of a 27-bed state-of-the-art critical care complex. Each bed space/cubicle operates clinically as a self-contained area. Each area is divided by partitioning enhancing the control of infection.

A recent report in 2004 provided detailed analysis on the demands on the service. There has been a significant increase in service demands, in line with population increases for the Western Region. In 2000, 470 patients used the critical care services, and latest validated figures show that the admissions have increased two-fold to 970 patients by end of 2004. (Silke, M.J, 2004) . National Health Policy is working towards individual regions becoming self sufficient in the delivery of health care. Galway Regional Hospitals (GRH) is designated as the Supra-Regional site for the Western Seaboard. The Critical Care Services at GRH actively role model as a supra-regional service, the most complex critically ill patients are presently referred to the unit for specialist treatments not available elsewhere in the region. Examples include acute lung injury rehabilitation with high frequency oscillator ventilation, continuous renal dialysis or specialist drugs therapies for acute sepsis (infection) management.

2.2 Phase II Capital/equipping projects

Approval for the Phase II Capital development Works was received from the Department of Health & Children on May 31st 2000. It consists of a Ђ100M + development to augment the existing service profile and introduce a range of new services. The scope of the work includes the construction in three phases (A,B,C) over a 36 month period and commenced 26th June 2000. Phase C of the project involved the construction and equipping of a critical care block and provided for a 12-bed ICU, 6-Bed intermediate care High Dependency Unit, 3-Bed Burns ICU and 6-Bed Cardiothoracic ICU. Beds are put into clinical use on a phased basis as funding allows.

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