Critical Care Informatics
Contents
Introduction
Intensive care medicine involves care of the sickest patients across the age spectrum, from neonates through pediatrics and into adulthood [1]. Patients typically require invasive monitoring or advanced organ support, including invasive ventilation, dialysis, blood pressure support and extracorporeal membranous oxygenation (ECMO). The role of clinical informatics is expanding in the critical care environment, with opportunities to advance clinical care, research and training.
Perceived Need
The practice of intensive care has a great need for the application of informatics principles. In a fast-paced clinical environment, errors are unfortunately frequent and often preventable. One study estimated the rate per 1000 patient-days of adverse events at 80.5, and preventable adverse events at 36.2 Cite error: Invalid <ref>
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invalid names, e.g. too many. Care in the ICU is also expensive, accounting for approximately 1/7th of hospital care and 4.1% of national health expenditures [2]. Monitors and frequent observations generate a vast amount of data, but this data is often not cataloged, stored and mined appropriately to be considered valuable “information” [3].
Too much data, not enough information – quote Schmidt slides
http://www.cs.columbia.edu/igert/courses/E6898/Schmidt_slides.pdf
https://www.ncbi.nlm.nih.gov/pubmed/25068389
Specialties
https://www.ncbi.nlm.nih.gov/pubmed/15154996
Medical Critical Care
Surgical Critical Care
Pediatric Critical Care
Neuro Critical Care
Neuro critical care involves intensive care with a focus on injuries of the nervous system, including stroke, traumatic brain injury and status epilepticus. Typically these units are staffed with providers trained in both neurology and critical care medicine, bringing together the right specialists for the care of these patients.
Multimodal monitoring
Not necessarily unique to neuro critical care is the practice of multi-modal monitoring, or the integration of several streams of data into a single monitoring system. For example, important to the care of a seizing patient with a non-invasive airway is both the respiratory monitoring (from a ventilator) and the electro-encephalographic (EEG) signals. Integration of these signals for prediction of patient course is an area of active research.
Neonatology
Neonatalogy is the specialty of medicine tasked with the care of the neonate, often premature or with other complicating medical conditions requiring intensive care.
Maternal & Fetal medicine
Nursing Informatics
Informatics in Clinical Practice
https://www.ncbi.nlm.nih.gov/pubmed/25068389 Gleaning knowledge from critical care
Technologies
https://www.ncbi.nlm.nih.gov/pubmed/12640613
Interoperability
- BedMaster - Novou
Jacono FJ, De Georgia MA, Wilson CG, Dick TE, Loparo KA. Data Acquisition and Complex Systems Analysis in Critical Care: Developing the Intensive Care Unit of the Future. Healthcare Engineering. 2010. - Developing a suite of complex tools including: Dimensional Variance, Linear Properties, Nonlinear Properties, Attractor Properties, Predictability
Tele-Medicine & Remote Monitoring
https://www.ncbi.nlm.nih.gov/pubmed/27634628 Nick Slamon
Research
http://www.mayo.edu/research/labs/clinical-informatics-intensive-care/overview
https://www.physionet.org/ - from http://lcp.mit.edu/
Virtual PICU (http://vpicu.net/) – Randall Wetzel in UCLA
DRAPER Lab, Columbia PREDICT: Pattern Representation and Evaluation of Data through Integration, Correlation, and Transformation
http://www.sickkids.ca/Critical-Care/programs-and-services/T3/index.html
Databases for Research
MIMIC database (MIMIC III - https://www.ncbi.nlm.nih.gov/pubmed/27219127)
VPS – collaborative sharing environment https://portal.myvps.org/login
Education
Fellowship training is available in critical care and clinical informatics. The Accredication Council for Graduate Medical Education (ACGME) [4] certifies fellowship training programs that meet criteria for academic rigor as well as institutional support and monitoring. A list of applicable fellowships can be found below:
- Pulmonary & Critical Care Fellowships
- Neonatal - Perinatal Fellowships
- Pediatric Critical Care Fellowships
- Clinical Informatics Fellowships
Societies, Conferences & Meetings
Academic societies relevant to the practice of critial care informatics are listed below, with appropriate links:
- Society of Critical Care in Medicine link
- American Medical Informatics Association (AMIA) link
- AMIA Intensive Care Informatics Working Group link
References
- ↑ Wikipedia Entry: Intensive Care Medicine (Accessed 2017-10-18) Link
- ↑ PMID 19730257
- ↑ Schmidt, J. Michael. Lecture: Biomedical Engineering and Informatics Applications in Critical Care. Columbia University Medical Center (Accessed: 2017-10-18) Slides
- ↑ Accreditation Council for Graduate Medical Education: Website (Accessed 2017-10-18) Site
Submitted by Adam Dziorny