ICU decision support
Twelve minutes.Nine patients.Critiva drafts.You sign.
It reads the whole encounter and proposes an assessment and a set of orders, each carrying the value it rests on. Nothing reaches a patient until a doctor edits it and signs it.
- MAP
- 58 mmHg
- Heart rate
- 118 bpm
- Lactate
- 4.2 mmol/L
- Urine 4 h
- 0.3 mL/kg/h
- Noradrenaline
- 0.10 mcg/kg/min
The problem
The knowledge is not the missing part.
A round is a reading task before it is a thinking one: vitals, labs, medications, imaging and three shifts of notes, for every bed, before anything can be decided. The four figures below are published research on what gets lost in that. None of the four is a measurement of Critiva.
1 in 10
intensive care patients experience an adverse event, and most of the serious ones are judged preventable.
Rothschild et al., Crit Care Med, 20057.6%
is the fall in survival for every hour antibiotics are delayed after septic shock begins.
Kumar et al., Crit Care Med, 200628%
of intensive care patients who died had an error in working out what was wrong, found at autopsy.
Winters et al., BMJ Qual Saf, 2012~50%
of clinically relevant information is lost at a shift handover when nothing structured carries it across.
Bomba and Prakash, Resuscitation, 2005How it works
Between the chart and the doctor. Never between the doctor and the patient.
- 01
It reads the encounter
Vitals, labs, medications, imaging reports, events and nurse notes, as the ward already recorded them. Not a summary somebody typed for it.
- 02
It drafts the assessment and the orders
A full plan, each order carrying the value it rests on: the reading, the weight, the lab and the time it was taken. An order with no basis is an order you cannot check.
- 03
A doctor edits and signs
They keep, change, add and drop, then sign. That signature is what reaches the patient, and nothing reaches the patient without it.
- 04
What the doctor changed becomes the signal
Kept, edited, added, dropped. The difference between the drafted plan and the signed one is a record of how this unit actually practises, and it is what the next draft is taught from.
The safety gate
What it will not put in front of you.
A system that never refuses has not thought about being wrong. These four are enforced in code rather than asked of the model, so none of them depends on a good day.
Orders that conflict with an allergy recorded in the chart are withheld before a doctor reads the plan.
A value nobody measured is not stated, and is not used to calculate a dose.
Severity scores are computed from the record. A score whose inputs are missing is reported as incomplete, and its predicted mortality is withheld rather than estimated.
The clinical values a plan rests on, kidney function, dosing weights, electrolyte corrections and fluid deficits, are calculated in code rather than inferred by the model.
Where it stops
The gate is narrow, and that is the argument.
Guessing a trigger fails in both directions. Too narrow and the gate never fires. Too wide and it holds back correct orders, which is how a safety feature gets switched off by the people it protects.
Only rules whose trigger is a field in the record are enforced. Rules that turn on clinical judgement go to the doctor rather than being guessed at, because a gate that withholds correct orders is a gate clinicians switch off.
Evaluating this for a unit raises a different set of questions.
For hospitalsTalk to us
Run it on your own cases.
We will walk you through what the software returns on a real encounter from your unit, including the parts it gets wrong.
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