Anesthesia Information Management System Alerts Can Improve Patient Care—But Raise Design and Implementation Challenges

Article ID: 638487

Released: 14-Aug-2015 10:45 AM EDT

Source Newsroom: Wolters Kluwer Health: Lippincott Williams and Wilkins

Newswise — August 14, 2015 – Automated alerts generated using data from hospital anesthesia information management systems (AIMS) are a promising approach to influencing the behavior of anesthesia providers—with the goal of improving care for patients undergoing surgery, according to a paper published in Anesthesia & Analgesia.

But developers must address a wide range of issues and concerns to ensure that alerts are reaching the right people, at the right time, to be effective in producing the desired changes, write Dr. Richard H. Epstein of Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, and colleagues.

Alerts Use Automated Data Systems to Target Anesthesia CareModern hospital AIMS routinely collect a vast amount of data on patient status and patient care. Clinicians and researchers are interested in mining these data to develop alert systems to improve key aspects of patient care and monitoring during surgery. Studies have shown that such anesthesia clinical decision support (CDS) systems can increase adherence to protocols and improve financial performance—but have yet to demonstrate improved clinical outcomes.

Designing and implementing such systems entails a "multitude of concerns" that must be recognized and addressed, in order to produce the desired effects. To illustrate these complexities, Dr. Epstein and coauthors share their experience in developing two different CDS interventions using AIMS data. The first case example concerns an effort to reduce fresh gas flow rates when using inhaled anesthetics. That's important not only for cost control, but also to reduce the environmental impact of gases ventilated to the atmosphere.

In this case, a "post hoc" approach was deemed an appropriate first step. An automated system was designed in which each anesthesiologist received a monthly email providing feedback on flow rates over his or her ten most recent cases. On evaluation, fresh gas flow rates decreased significantly from before to after the alert system was implemented.

Other situations call for more immediate feedback is to achieve the desired improvement. That's illustrated in the second case example: an effort to reduce gaps in routine blood pressure (BP) during surgery. While measuring BP every five minutes is the standard, gaps of ten minutes or longer are common.

This case required a "near real-time" approach, with alerts sent directly to the operating room workstation where the patient's condition was being recorded. Evaluation found that the targeted improvements in BP monitoring were met, once alert intervals were decreased to six minutes. Over four years' follow-up, the number of weekly alerts remained about the same—suggesting a "lack of long-term learning" and highlighting the need to continue the alert system.

Alert systems should not be implemented until their usefulness is confirmed, Dr. Epstein and colleagues emphasize. For example, they considered sending near real-time alerts regarding drops in blood oxygenation level (oxygen saturation)—but found that most such episodes resolved within minutes, before the alert could be sent. "Lack of utility should be assumed until testing shows otherwise, even if a benefit seems apparent," the researchers write.

Other concerns include possible unintended consequences of alert systems—for example, one study suggested that CDS reminders were leading to overuse use of anti-nausea drugs. Potential regulatory issues must be considered, such as the risk of running afoul of FDA rules on the use of CDS software or mobile devices. The authors also touch on the technical challenges of implementing and maintaining alert systems.

Although data collected by AIMS provide the opportunity to improve patient care in many ways, careful forethought and follow-up are needed to ensure that alerts are well-designed and effective, Dr. Epstein and coauthors believe. They conclude, "Our goal is to inform developers and users of CDS for AIMS about the multitude of concerns they should consider during development and implementation to increase effectiveness and mitigate potentially disruptive aspects of this technology." Anesthesia & Analgesia is published by Wolters Kluwer.

Read the article in Anesthesia & Analgesia.

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About Anesthesia & AnalgesiaAnesthesia & Analgesia was founded in 1922 and was issued bi-monthly until 1980, when it became a monthly publication. A&A is the leading journal for anesthesia clinicians and researchers and includes more than 500 articles annually in all areas related to anesthesia and analgesia, such as cardiovascular anesthesiology, patient safety, anesthetic pharmacology, and pain management. The journal is published on behalf of the IARS by Lippincott Williams & Wilkins (LWW), a division of Wolters Kluwer Health.

About the IARSThe International Anesthesia Research Society is a nonpolitical, not-for-profit medical society founded in 1922 to advance and support scientific research and education related to anesthesia, and to improve patient care through basic research. The IARS contributes nearly $1 million annually to fund anesthesia research; provides a forum for anesthesiology leaders to share information and ideas; maintains a worldwide membership of more than 15,000 physicians, physician residents, and others with doctoral degrees, as well as health professionals in anesthesia related practice; sponsors the SmartTots initiative in partnership with the FDA; supports the resident education initiative OpenAnesthesia; and publishes two journals, Anesthesia & Analgesia and A&A Case Reports n.

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