The implementation of an anesthesia information management system

Change in staff anesthesiologists' opinions of an Anesthesia Information Management System (AIMS)

Following introduction of an Anesthesia Information Management System (AIMS) at a tertiary care, academic health sciences centre, a quality assurance initiative was conducted to assess staff opinions of the AIMS using a previously published, anonymous survey tool at 1 and 5 years following AIMS introduction. At 5 years compared to 1 year after implementation of AIMS, the majority (18 of 24, 75%) of responses to the survey questions had a statistically significant change (P < 0.05) in the proportion of respondents favoring AIMS compared to the 1 year survey. Domains noted to be more favorable 5 years compared to 1 year after AIMS introduction included patient safety in the Operating Rooms and Post-Anesthesia Care Unit, quality of handover and overall documentation, and communication amongst healthcare workers. The ideal time period at which to assess AIMS after introduction is not clear.

Incidence of Artifacts and Deviating Values in Research Data Obtained from an Anesthesia Information Management System in Children

BACKGROUND

Vital parameter data collected in anesthesia information management systems are often used for clinical research. The validity of this type of research is dependent on the number of artifacts.

METHODS

In this prospective observational cohort study, the incidence of artifacts in anesthesia information management system data was investigated in children undergoing anesthesia for noncardiac procedures. Secondary outcomes included the incidence of artifacts among deviating and nondeviating values, among the anesthesia phases, and among different anesthetic techniques.

RESULTS

We included 136 anesthetics representing 10,236 min of anesthesia time. The incidence of artifacts was 0.5% for heart rate (95% CI: 0.4 to 0.7%), 1.3% for oxygen saturation (1.1 to 1.5%), 7.5% for end-tidal carbon dioxide (6.9 to 8.0%), 5.0% for noninvasive blood pressure (4.0 to 6.0%), and 7.3% for invasive blood pressure (5.9 to 8.8%). The incidence of artifacts among deviating values was 3.1% for heart rate (2.1 to 4.4%), 10.8% for oxygen saturation (7.6 to 14.8%), 14.1% for end-tidal carbon dioxide (13.0 to 15.2%), 14.4% for noninvasive blood pressure (10.3 to 19.4%), and 38.4% for invasive blood pressure (30.3 to 47.1%).

CONCLUSIONS

Not all values in anesthesia information management systems are valid. The incidence of artifacts stored in the present pediatric anesthesia practice was low for heart rate and oxygen saturation, whereas noninvasive and invasive blood pressure and end-tidal carbon dioxide had higher artifact incidences. Deviating values are more often artifacts than values in a normal range, and artifacts are associated with the phase of anesthesia and anesthetic technique. Development of (automatic) data validation systems or solutions to deal with artifacts in data is warranted.

The organizational and clinical impact of integrating bedside equipment to an information system: a systematic literature review of patient data management systems (PDMS)

OBJECTIVE

The introduction of an information system integrated to bedside equipment requires significant financial and resource investment; therefore understanding the potential impact is beneficial for decision-makers. However, no systematic literature reviews (SLRs) focus on this topic. This SLR aims to gather evidence on the impact of the aforementioned system, also known as a patient data management system (PDMS) on both organizational and clinical outcomes.

MATERIALS AND METHODS

A literature search was performed using the databases Medline/PubMed and CINHAL for English articles published between January 2000 and December 2012. A quality assessment was performed on articles deemed relevant for the SLR.

RESULTS

Eighteen articles were included in the SLR. Sixteen articles investigated the impact of a PDMS on the organizational outcomes, comprising descriptive, quantitative and qualitative studies. A PDMS was found to reduce the charting time, increase the time spent on direct patient care and reduce the occurrence of errors. Only two articles investigated the clinical impact of a PDMS. Both reported an improvement in clinical outcomes when a PDMS was integrated with a clinical decision support system (CDSS).

CONCLUSIONS

A PDMS has shown to offer many advantages in both the efficiency and the quality of care delivered to the patient. In addition, a PDMS integrated to a CDSS may improve clinical outcomes, although further studies are required for validation.

Artifacts in research data obtained from an anesthesia information and management system

PURPOSE

Artifacts in anesthesia information management system (AIMS) databases may influence research results. Filtering during data capturing can prevent artifacts from being stored. In this prospective study, we assessed the reliability of AIMS data by determining the incidence of artifactual values stored in the AIMS.

METHODS

Vital parameter values regarding 86 surgical patients were collected in the AIMS both manually and automatically after filtering using the median value per minute. The percentage of artifactual values with a 95% confidence interval (CI) was calculated for each parameter. Secondary outcomes included the number of values that deviated from a predefined baseline, the percentage of these deviations that were caused by artifacts, the number of episodes across which these artifacts were distributed, and the most common causes of artifacts.

RESULTS

Altogether, 9,534 min of anesthesia time were recorded. The overall percentages of artifacts were: 0.0 for heart rate (95% CI: 0.0 to 0.1), 0.3 for oxygen saturation (95% CI: 0.2 to 0.4), 4.7 for ST-segment (95% CI: 4.3 to 5.2), 2.3 for noninvasive blood pressure values (95% CI: 1.8 to 2.9), and 14 for invasive blood pressure values (95% CI: 12 to 15). Artifacts as a percentage of deviations from baseline were: 1.6 for heart rate (95% CI: 0.4 to 5.7), 24 for saturation (95% CI: 18 to 32), 83 for ST-segment (95% CI: 76 to 87), 3.3 for noninvasive blood pressure values (95% CI: 2.5 to 87), and 27 for invasive blood pressure values (95% CI: 24 to 31).

CONCLUSIONS

Storing a median value per minute to filter capturing of vital parameter values in an AIMS database provides reliable data for heart rate and oxygen saturation and acceptable reliability for noninvasive blood pressure data. Knowledge about the method of artifact filtering is essential in studies using AIMS data.

A survey of user acceptance of electronic patient anesthesia records

Background

An anesthesia information management system (AIMS), although not widely used in Korea, will eventually replace handwritten records. This hospital began using AIMS in April 2010. The purpose of this study was to evaluate users' attitudes concerning AIMS and to compare them with manual documentation in the operating room (OR).

Methods

A structured questionnaire focused on satisfaction with electronic anesthetic records and comparison with handwritten anesthesia records was administered to anesthesiologists, trainees, and nurses during February 2011 and the responses were collected anonymously during March 2011.

Results

A total of 28 anesthesiologists, 27 trainees, and 47 nurses responded to this survey. Most participants involved in this survey were satisfied with AIMS (96.3%, 82.2%, and 89.3% of trainees, anesthesiologists, and nurses, respectively) and preferred AIMS over handwritten anesthesia records in 96.3%, 71.4%, and 97.9% of trainees, anesthesiologists, and nurses, respectively. However, there were also criticisms of AIMS related to user-discomfort during short, simple or emergency surgeries, doubtful legal status, and inconvenient placement of the system.

Conclusions

Overall, most of the anesthetic practitioners in this hospital quickly accepted and prefer AIMS over the handwritten anesthetic records in the OR.

Double Lumen Tubes: Usage and Performance by Frequent and Infrequent Users

Double lumen tubes (DLT) are commonly used to achieve lung isolation (LI). Not all anesthesiologists are frequent DLT users. Our thoracic surgical service is covered by sub-specialty anesthesiologists who are frequent DLT users. Thus, we are in a position to evaluate the performance of infrequent DLT users relative to frequent DLT users. Using statistical methods, we examined the incidence, duration and severity of hypoxia, hypercapnea and high airway pressures for patients receiving LI via DLTs placed by infrequent versus frequent users. The incidence of low SpO2, high EtCO2, or high PIP was not different between frequent and infrequent DLT users. However, when these events do occur, they are more severe (elevated EtCO2 duration, lower SpO2, higher EtCO2, higher airway pressure) among infrequent than frequent DLT users. The practical significance of these differences, which are small, is unproven. However, when episodes of hypercapnea do occur, they last much longer among infrequent than frequent DLT users.

[Evaluation of a new computerized recording system for preoperative assessment data]

BACKGROUND AND OBJECTIVES

Little information is available on the use of computerized systems in preanesthetic assessment. Our aim was to evaluate staff acceptance of a computerized system for the structured recording of preoperative assessment data in our hospital. The time taken to complete the assessment was compared to the time usually taken to record the information on paper.

MATERIAL AND METHODS

Observational, descriptive cross-sectional survey of user satisfaction 3 months after the system had been launched. We later carried out a prospective observational study of 796 preanesthetic assessment visits, comparing the mean time the users took to record information on paper to the time required to enter the data into the computer, analyzing differences between anesthesiologists and according to American Society of Anesthesiologists (ASA) classification and patient age.

RESULTS

A total of 401 paper records and 395 electronic files were included. The users believed that the computerized system improved quality and accessibility of recorded data and clinical decision-making. The time required to enter data into the computer was believed to be the main drawback; the users took a mean (SD) 15.21 (5.41) minutes to enter the electronic data and 13.37 (5.08) minutes to record the information on paper (P < .001). There were also significant differences in the time taken to record data according to ASA classification and between anesthesiologists (P < .001).

CONCLUSIONS

In spite of drawbacks such as extra time taken to record electronic data, the users perceived benefits, such as improved quality and accessibility of records. For this reason, the computerized system was well accepted.

Shortcomings and challenges of information system adoption

The number of institutions implementing AIMS is increasing. Shortcomings in the design and implementation of EMRs have been associated with unanticipated consequences, including changes in workflow. These have often resulted from the carryover of paper-based documentation practices into an electronic environment. The new generation of mobile devices allows providers to have situational awareness of multiple care sites simultaneously, possibly allowing for improved proactive decision making. Although potentially facilitating safer anesthetic supervision, technologic and cultural barriers remain. Security, quality of information delivery, regulatory issues, and return on investment will continue as challenges in implementing and maintaining this new technology.

Anesthesia information management systems

PURPOSE OF REVIEW

This review will summarize and comment upon recent developments in the evolution and implementation of anesthesia information management systems (AIMS) in current practice.

RECENT FINDINGS

Availability of inexpensive hardware components has greatly reduced costs, and AIMS are now widely available as 'off-the-shelf' software systems, yet AIMS are currently in use in only a minority of institutions and anesthetic practices. AIMS have evolved rapidly from simple automated record-keeping systems to key components of modern medical information networks. The databases generated by AIMS are becoming the basis for establishing 'best practices' and for comparing patient care outcomes.

SUMMARY

The searchable, timed, and dated perioperative documentation generated by an AIMS appears to be an evolving requirement for contemporary anesthetic practice. The obstacles to more widespread AIMS adoption appear to be behavioral and financial rather than technical.

The impact of an electronic reminder on the use of alarms after separation from cardiopulmonary bypass

INTRODUCTION

During cardiopulmonary bypass (CPB) monitor alarms are routinely disabled. Failure to reactivate these alarms after CPB may jeopardize patient safety. We have produced an electronic reminder that automatically alerts clinicians to reactivate alarms after CPB and have evaluated the alarm reactivation rate after its implementation.

METHODS

We developed and implemented an algorithm that identifies separation from CPB by the return of pulsatile flow and of mechanical ventilation, and checks alarm status (activated, disabled or silenced). If alarms have not been reactivated after separation from CPB, an electronic reminder appears. Data were collected during three time periods: Stage I (304 patients)--baseline period before implementation of the electronic reminder; Stage II (256 patients)--after implementation; Stage III-(435 patients) after a single educational departmental meeting, at the end of Stage II. Incidence of proper alarm reactivation and the number of electronic reminders per patient were compared among stages.

RESULTS

The rate of alarm reactivation at baseline (Stage I) was 22%, increased to 63% (Stage II), and again to 83% during Stage III (P < 0.001). The spontaneous alarm reactivation rate before the appearance of the electronic reminder on the anesthesia information management system screen increased from 19% at Stage II to 42% at stage III (P < 0.001).

CONCLUSION

Introducing an automatic electronic reminder significantly increased the rate of alarm reactivation after separation from CPB. Real-time computerized decision-support tools can be developed within anesthesia information management system and may be useful for improving safety during anesthesia.

A survey of anesthesiologists' and nurses' attitudes toward the implementation of an Anesthesia Information Management System on a labor and delivery floor

BACKGROUND

An anesthesia information management system (AIMS) is most frequently used in the operating room, but not on labor and delivery (L&D). The purpose of this study is to describe the implementation of an AIMS on L&D and the attitudes of practitioners (anesthesiologists and nurses) toward the system.

METHODS

The anesthesiology survey focused on satisfaction with the L&D AIMS, comparison of the L&D AIMS with a handwritten anesthesia record, and comparison of the L&D AIMS with the operating room AIMS. The nursing survey focused on nursing satisfaction with the L&D AIMS and comparison of the L&D AIMS with a handwritten anesthesia record.

RESULTS

Most anesthesiologists (76%) were satisfied with the L&D AIMS and 73% would not want to revert back to the paper record. However, most anesthesiologists felt the operating room AIMS was either superior or equal to the L&D AIMS. Although few nurses (4%) preferred the anesthesiologists revert back to the handwritten record overall, the nurses were neutral in their assessment of the AIMS. Most of the criticism related to the location of the system; 56% believed it was not in a convenient location and 74% thought the AIMS equipment "got in their way".

CONCLUSIONS

Overall, the anesthesiologists and nurses are satisfied with the L&D AIMS and would not want to switch back to a handwritten record. We conclude that AIMS should not be limited to the operating room setting and can successfully be used in L&D.