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Challenges to Real-Time Decision Support in Health Care.


In: Henriksen K, Battles JB, Keyes MA, Grady ML, editors.


Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 2: Culture and Redesign). Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Aug.
Advances in Patient Safety.

Author information

Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia (Dr. Fitzgerald); The National Trauma Research Institute, Melbourne, Australia (Dr. Fitzgerald, Mr. Farrow, Ms. Murray); Swinburne University of Technology, Melbourne, Australia (Ms. Scicluna); The Shock Trauma Center, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD (Dr. Xiao); The National Study Center for Trauma and Emergency Medical Systems, Baltimore, MD (Dr. Xiao, Dr. Mackenzie)


This article describes challenges in the design and development of a decision support system for trauma patient resuscitation that is used to encourage consistency and reduce error rates. The Trauma Reception and Resuscitation Project links real-time, computer-generated prompts from best practice algorithms via visual and auditory displays. Its functionality is now being tested. Evaluation of this decision support approach can employ patient chart review or observation, but we describe an approach that measures the process of care by video audit. Key process problems in trauma management (e.g., errors of omission, commission, and misprioritization) are identified. The video record provides a framework for learning and feedback. Future testing and development of this system will include a randomized clinical trial and technology enhancement.

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