Guardian: A prototype intelligent agent for intensive-care monitoring

Abstract

Effective monitoring of device-supported patients in the intensive care unit (ICU) is complex, involving interpretation of many variables, comparative evaluation of many therapy options, and control of many patient-management parameters. Even skilled clinicians make errors that limit the quality of care, harm patients, or cause life-threatening situations. A growing body of research aims to improve ICU monitoring with computer technology. Most of this research falls in two areas: (a) short-term engineering of practical solutions to narrowly defined immediate problems (e.g. smart alarm systems); or (b) basic research on fundamental issues potentially relevant to ICU monitoring (e.g. temporal reasoning). By contrast, our project aims to develop a more comprehensive ‘intelligent agent’, having a broad range of capabilities, to cooperate on the ICU team. We do not aim to produce a practical system suitable for near-term deployment in the ICU, but rather a ‘proof of concept’, an experimental system that: (a) demonstrably performs and coordinates a range of intelligent reasoning tasks of use in ICU monitoring; (b) does so reliably in a significant range of medical situations; and (c) arguably will scale up to meet the comprehensive set of practical requirements with an appropriate development effort. We have developed an experimental system called Guardian, which exhibits several of the required capabilities and utilizes an underlying architecture hypothesized to support the full range of required capabilities. In this paper, we describe the Guardian system, its architecture, and its current knowledge base. We describe its performance and summarize the results of preliminary evaluations. Finally, we discuss ongoing and planned research on Guardian.