Extending clinical information systems design in the ICU

Abstract

Miller and Sanderson (2003b) presented promising results for a prototype clinical information design developed according to Ecological Interface Design principles, but the size of the prototype made it impractical for onscreen display. This paper replicates the previous study using an onscreen presentation of the original EID divided according to functional systems. As in the original study, nurses' ability to detect patient change events was enhanced using the onscreen EID. However, there are differences between doctors' performance using the original and using the onscreen EID. Unlike the original participants, doctors were better able to agree about physiological systems failure, but also unlike the original participants, showed no significant differences in their ability to agree about the patients' current diagnostic state using the onscreen EID or conventional charts. This later ability is clinically more important. It was concluded that while dividing the original EID had no appreciable effect on nurses and enhanced some abilities among doctors, this was at the expense of more clinically significant abilities. It may be necessary to rethink the appropriateness of limited real-estate, office style computer terminals in intensive care units.