One aspect of PICU I have not commented on is the use of electronic patient records. In terms of going through the nursing notes – with automatically calculated hourly fluid balances, urine outputs in ml/kg/h and the facility to plot any parameter on a graph – they were brilliant. Apart from the network being infuriatingly slow – at times, the speed of the page loading was the limiting factor to how quickly you could get things done. Which is pretty stupid with a critically ill patient. We also used the system for prescriptions, ward round notes and admissions and discharges, so the number of computer terminals (not nearly enough) put a limit on the efficiency of the whole unit. In addition to the general slowness (which was in any case probably due to our servers rather than the software), the ‘medical note’ part of the software was a complete nightmare. To this day I am not sure how much of it was down to the design (which was not brilliant) and how much to the users (who often just didn’t bother to write anything, even though they would have in paper notes).
It took me a while to realise that the electronic record retains the most recent entry (even if it is a few days old) in each field until it is edited, so it is not immediately obvious that the note that appears isn’t current (though it may be headed ‘last 24 hours’), and even when one realises this, it is necessary to click on each previous ‘session’ in order to find out when it was written. This is partly down to user sloppiness (in paper notes, you would do a 24-hourly summary every day) and partly to software stupidity (how hard can it be to tag the date and time to the entry, and make it appear in the actual text box at each edit). A typical (and relatively benign) example would be “CT abdomen performed, result awaited”. This tends to be left in the field during the following 24 hours, particularly if the said result is still pending. It is compounded by the fact we all work shifts, so if the scan had been done on, say the evening of 16/1/10, by 18/1/10, the patient may have been handed over to a different doctor twice, maybe 3 times, and the doctor who made the entry might be on a rota’d day off, or night shifts. The obvious solution (which I adopted latterly) would be to enter something like “CT abdomen performed 16/1/10, formal report expected by 18/1/10”. I just find it ridiculous that a piece of software that can plot the patient’s CRP for the last 2 weeks can’t even tag a date and time to a paragraph of text, and display it in an intuitive way.
But what prompted this post was actually a rush of ‘computer love’. I’ve just looked up an article in Pediatrics on the (lack of) effect of dexamethasone and glycerol on preventing hearing impairment in children with bacterial meningitis http://pediatrics.aappublications.org/cgi/content/full/125/1/e1, having come across a summary of it in my Google Reader. I wanted to find out what dose of dexamethasone the authors had used. So I clicked on the heading, which brought me to the journal’s website, where I got the full text free. All while enjoying (a rather late) breakfast. [ I am on leave] Not so long ago (when I was in medical school in the late ’90s to early ’00s, in fact), one would have had to head to the library in order to get the full text of any journal article. And Google Reader didn’t exist. So I wouldn’t have been scanning the journals over breakfast at all.
So are we all more knowledgeable then? I don’t know. But reading stuff on my computer at the breakfast table definitely beats trekking to the library. And I’m also ambivalent about computerised patient records. I’d love to help design a software package though. (The user interface, that is, not the actual workings of the thing)