Wednesday, March 16, 2011

Module 5: Decision Support for Care Delivery

The readings for this module truly made me reassess how I make clinical decisions. Listening to the lecture by Daniel Kahneman, issues that were at one point in the back of my mind, "out of sight, out of mind mentality," were resurfaced. I enjoyed his representation of the nurses intuition. There are many times when I simply "know" something is not right with a child in the neonatal intensive care unit (NICU), even though there may not be direct clinical indicators. Is this intuition? Knowledge from experiences? Possibly something in the middle or both? When I first began working in the NICU, I had no clinical experience in this area. I had worked with adults in the cardiothoracic intensive care unit (CICU), but never this specialized population. When looking back, did I simply not recognize things as early as I do now? It is difficult to think about situations when you sit there and say, "What could I have done differently? What did I miss?" Unfortunately, this is part of medicine, and you may have had all your things in order and not missed a piece of the puzzle, but something unfortunate happened. I have learned not to dwell on such experiences, but take them in strides and learn from them. 

The use of clinical support decision systems may be extremely useful, depending on the appropriateness of the system. I examined the DXplain system for the assignment of this module, and concluded that this system may not be beneficial in the NICU. If systems were developed with the specialized population of those in the NICU, they may be extremely useful. 

Finally, appropriate education related to clinical decision support systems must be implemented. Personally, many coworkers "dread" implementing new and updated computerized medical charting. We must continue to educate each other regarding the need for such changes as well as the benefits associated. Not everything is going to be perfect the first time, but with appropriate communication, we can make the necessary modifications  in such systems that will benefit specialized populations of patients, such as the NICU.

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