Journal of Clinical Monitoring and Computing

, Volume 29, Issue 2, pp 263–269 | Cite as

The implementation of an Intensive Care Information System allows shortening the ICU length of stay

  • Eric Levesque
  • Emir Hoti
  • Daniel Azoulay
  • Philippe Ichai
  • Didier Samuel
  • Faouzi Saliba
Original Research


Intensive care information systems (ICIS) implemented in intensive care unit (ICU) were shown to improve patient safety, reduce medical errors and increase the time devolved by medical/nursing staff to patients care. Data on the real impact of ICIS on patient outcome are scarce. This study aimed to evaluate the effects of ICIS on the outcome of critically-ill patients. From January 2004 to August 2006, 1,397 patients admitted to our ICU were enrolled in this observational study. This period was divided in two phases: before the implementation of ICIS (BEFORE) and after implementation of ICIS (AFTER). We compared standard ICU patient’s outcomes: mortality, length of stay in ICU, hospital stay, and the re-admission rate depending upon BEFORE and AFTER. Although patients admitted AFTER were more severely ill than those of BEFORE (SAPS II: 32.1 ± 17.5 vs. 30.5 ± 18.5, p = 0.014, respectively), their ICU length of stay was significantly shorter (8.4 ± 15.2 vs. 6.8 ± 12.9 days; p = 0.048) while the re-admission rate and mortality rate were similar (4.4 vs. 4.2 %; p = 0.86, and 9.6 vs 11.2 % p = 0.35, respectively) in patients admitted AFTER. We observed that the implementation of ICIS allowed shortening of ICU length of stay without altering other patient outcomes.


Intensive care information systems Intensive care unit Outcome Length of stay Mortality 


Conflict of interest

The authors who have taken part in this study do not have any relationship with the manufacturers of any the drugs involved/used for patients either in the past or present and did not receive any funding from the manufacturer to carry out this research.


  1. 1.
    Varon J, Marik PE. Clinical information systems and the electronic medical record in the intensive care unit. Curr Opin Crit Care. 2002;8:616–24.CrossRefPubMedGoogle Scholar
  2. 2.
    Colpaert K, Vanbelleghem S, Danneels C, et al. Has information technology finally been adopted in Flemish intensive care units? BMC Med Inform Decis Mak. 2010;10:62.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Bosman RJ, Rood E, Oudemans van Straaten HM, Van der Spoel JI, Wester JP, Zandstra DF. Intensive Care Information System reduces documentation time of the nurses after cardiothoracic surgery. Intensive Care Med. 2003;29:83–90.PubMedGoogle Scholar
  4. 4.
    Wong DH, Gallegos Y, Weinger MB, Clack S, Slagle J, Anderson CT. Change in intensive care unit nurse task activity after installation of a third-generation intensive care unit information system. Crit Care Med. 2003;31:2488–94.CrossRefPubMedGoogle Scholar
  5. 5.
    Garg AX, Adhikari NK, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293:1223–38.CrossRefPubMedGoogle Scholar
  6. 6.
    Mollon B, Chong J Jr, Holbrook AM, Sung M, Thabane L, Foster G. Features predicting the success of computerized decision support for prescribing: a systematic review of randomized controlled trials. BMC Med Inform Decis Mak. 2009;9:11.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Kooij FO, Klok T, Hollmann MW, Kal JE. Decision Support increases guideline adherence for prescribing postoperative nausea and vomiting prophylaxis. Anesth Analg. 2008;106:893–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Dvir D, Cohen J, Singer P. Computerized energy balance and complications in critically ill patients: an observational study. Clin Nutr. 2006;25:37–44.CrossRefPubMedGoogle Scholar
  9. 9.
    Mador RL, Shaw NT. The impact of a Critical Care Information System (CCIS) on time spent charting and in direct patient care by staff in the ICU: a review of the literature. Int J Med Inform. 2009;78:435–45.CrossRefPubMedGoogle Scholar
  10. 10.
    Levesque E, Hoti E, Azoulay D, et al. Prospective evaluation of the prognostic scores for cirrhotic patients admitted to an intensive care unit. J Hepatol. 2012;56:95–102.CrossRefPubMedGoogle Scholar
  11. 11.
    Levesque E, Hoti E, Azoulay D, et al. Pulmonary complications following elective liver transplantation—Incidence, risk factors, and outcome. Transplantation. 2012;94:532–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957–63.CrossRefPubMedGoogle Scholar
  13. 13.
    McCambridge M, Jones K, Paxton H, Baker K, Sussman EJ, Etchason J. Association of Health Information Technology and Teleintensivist Coverage with decreased mortality and ventilator use in critically ill patients. Arch Intern Med. 2010;170:648–53.CrossRefPubMedGoogle Scholar
  14. 14.
    Rubenfeld GD. Using computerized medical databases to measure and to improve the quality of intensive care. J Crit Care. 2004;19:248–56.CrossRefPubMedGoogle Scholar
  15. 15.
    Thompson W, Dodek PM, Norena M, Dodek J. Computerized physician order entry of diagnostic tests in an intensive care unit is associated with improved timeliness of service. Crit Care Med. 2004;32:1306–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Rood E, Bosman RJ, van der Spoel JL, Taylor P, Zandstra DF. Use of a computerized guideline for glucose regulation in the intensive care unit improved both guideline adherence and glucose regulation. J Am Med Inform Assoc. 2005;12:172–80.CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Berger MM, Revelly JP, Wasserfallen JB, et al. Impact of a computerized information system on quality of nutritional support in the ICU. Nutrition. 2006;22:221–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Eden A, Pizov R, Toderis L, Kantor G, Perel A. The impact of an electronic reminder in the use of alarms after separation from cardiopulmonary bypass. Anesth Analg. 2009;108:1203–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Morrison C, Jones M, Blackwell A, Vuylsteke A. Electronic patient record use during ward rounds: a qualitative study of interaction between medical staff. Crit Care. 2008;12:R148.CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    Garrouste-Orgeas M, Timsit JF, Vesin A, et al. Selected Medical errors in the Intensice Care Unit. Am J Resp Crit Care Med. 2009;181:134–42.CrossRefPubMedGoogle Scholar
  21. 21.
    Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors observed in 36 Health care facilities. Arch Intern Med. 2002;162:1897–903.CrossRefPubMedGoogle Scholar
  22. 22.
    Ali J, Barrow L, Vuylsteke A. The impact of computerised physician order entry on prescribing practices in a cardiothoracic intensive care unit. Anasesthesia. 2010;65:119–23.CrossRefGoogle Scholar
  23. 23.
    Evans KD, Benham SW, Garrard CS. A comparison of handwritten and computer-assisted prescriptions in an intensive care unit. Crit Care. 1998;2:73–8.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Shulman R, Singer M, Goldstone J, Bellingan G. Medication errors: a prospective cohort study of hand-written and computerised physician order entry in the intensive care unit. Crit Care. 2005;9:R516–21.CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359–67.CrossRefPubMedGoogle Scholar
  26. 26.
    Boord JB, Sharifi M, Greevy RA, et al. Computer-based insulin infusion protocol improves glycemia control over manual protocol. J Am Med Inform Assoc. 2007;14:278–87.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Wong DH, Gallegos Y, Weinger MB, et al. Changes in intensive care unit nurse task activity after installation of a third-generation intensive care unit information system. Crit Care Med. 2003;31:2488–94.CrossRefPubMedGoogle Scholar
  28. 28.
    Levesque E, Hoti E, de La Serna S, et al. The positive financial impact of using an Intensive Care Information System in a tertiary intensive care unit. Int J Med Inform. 2013;82:177–84.CrossRefPubMedGoogle Scholar
  29. 29.
    Marasovic C, Kenney C, Elliott D, Sindhusake D. Attitudes of Australian nurses toward the implementation of a clinical information system. Comput Nurs. 1997;15:91–8.PubMedGoogle Scholar
  30. 30.
    Jha AK, DesRoches CM, Campbell EG, et al. Use of electronic health records in US Hospitals. N Engl J Med. 2009;360:1628–38.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Eric Levesque
    • 1
    • 2
  • Emir Hoti
    • 1
    • 3
  • Daniel Azoulay
    • 4
  • Philippe Ichai
    • 1
  • Didier Samuel
    • 1
  • Faouzi Saliba
    • 1
  1. 1.Centre Hépato-Biliaire, Hôpital Paul BrousseAP-HPVillejuifFrance
  2. 2.Service de Réanimation Digestive et Transplantation Hépatique, Hôpital Henri MondorAP-HPCréteilFrance
  3. 3.Liver Transplant UnitSaint Vincent’s University HospitalElm Park, Dublin 4Ireland
  4. 4.HPB Unit, Hôpital Henri MondorAP-HPCréteilFrance

Personalised recommendations