Intraoperative Clinical Decision Support for Anesthesia: A Narrative Review of Available Systems.

With increasing adoption of anesthesia information management systems (AIMS), there is growing interest in utilizing AIMS data for intraoperative clinical decision support (CDS). CDS for anesthesia has the potential for improving quality of care, patient safety, billing, and compliance. Intraoperative CDS can range from passive and post hoc systems to active real-time systems that can detect ongoing clinical issues and deviations from best practice care.

Decisional practices and patterns of intraoperative glucose management in an academic medical center.

Objective: To understand the decisional practices of anesthesia providers in managing intraoperative glucose levels.

Design: This is a retrospective cohort study.

Setting: Operating rooms in an academic medical center.

Intraoperative blood glucose management: impact of a real-time decision support system on adherence to institutional protocol.

Poor perioperative glycemic management can lead to negative surgical outcome. Improved compliance to glucose control protocol could lead to better glucose management. An Anesthesia Information Management System based decision support system-Smart Anesthesia Manager™ (SAM) was used to generate real-time reminders to the anesthesia providers to closely adhere to our institutional glucose management protocol.

Resident Perceptions and Cost Analysis of a Virtual Patient Application for Anesthesia-Related Critical Incidents.

Background: Since there are limitations on the amount of time residents can spend in full-scale simulation sessions, we introduced a virtual patient application into our anesthesiology program to su pplement mannequin-based simulation sessions. Previous investigations have demonstrated a positive educational effect for virtual patients, but suggest that further research is needed to clarify how to effectively implement virtual patients in medical education. We present a description of the implementation of a virtual patient application in our residency training program, the residents' evaluation of their experience with the application, and a cost analysis of incorporation of the application into the residency program, in order to determine the residents' perceptions of the value and estimate the cost of using virtual patients in anesthesia residency training.

Anesthesia information management system-based near real-time decision support to manage intraoperative hypotension and hypertension.

Background: Intraoperative hypotension and hypertension are associated with adverse clinical outcomes and morbidity. Clinical decision support mediated through an anesthesia information management system (AIMS) has been shown to improve quality of care. We hypothesized that an AIMS-based clinical decision support system could be used to improve management of intraoperative hypotension and hypertension.

Reducing wastage of inhalation anesthetics using real-time decision support to notify of excessive fresh gas flow.

Background: Reduced consumption of inhalation anesthetics can be safely achieved by reducing excess fresh gas flow (FGF). In this study the authors describe the use of a real-time decision support tool to reduce excess FGF to lower, less wasteful levels.

Method: The authors applied a decision support tool called the Smart Anesthesia Manager™ (University of Washington, Seattle, WA) that analyzes real-time data from an Anesthesia Information Management System to notify the anesthesia team if FGF exceeds 1 l/min.

Near real-time notification of gaps in cuff blood pressure recordings for improved patient monitoring.

Blood pressure monitoring during anesthesia is an American Society of Anesthesiology standard. However, the anesthesia provider sometimes fails to engage the patient monitor to make periodic (generally every 3-5 min) measurements of Non-Invasive Blood Pressure (NIBP), which can lead to extended periods (>5 min) when blood pressure is not monitored. We describe a system to automatically detect such gaps in NIBP measurement and notify clinicians in real-time to initiate measurement.

Improving documentation of a beta-blocker quality measure through an anesthesia information management system and real-time notification of documentation errors.

Background: Continuation of perioperative beta-blockers for surgical patients who are receiving beta-blockers prior to arrival for surgery is an important quality measure (SCIP-Card-2). For this measure to be considered successful, name, date, and time of the perioperative beta-blocker must be documented. Alternately, if the beta-blocker is not given, the medical reason for not administering must be documented.

Smart Anesthesia Manager™ (SAM)--a real-time decision support system for anesthesia care during surgery.

Anesthesia information management systems (AIMS) are being increasingly used in the operating room to document anesthesia care. We developed a system, Smart Anesthesia Manager™ (SAM) that works in conjunction with an AIMS to provide clinical and billing decision support. SAM interrogates AIMS database in near real time, detects issues related to clinical care, billing and compliance, and material waste.

Automated electronic reminders to improve redosing of antibiotics during surgical cases: comparison of two approaches.

Background: Timely re-dosing of antibiotic for prolonged surgical cases is an important measure in reducing the risk of surgical site infections. For the anesthesia team, which generally administers the antibiotic re-doses, it is difficult to keep track of and remember the exact timing requirements. We explored the efficacy of two types of electronic reminders to aid the anesthesia team in performing timely antibiotic re-doses.

Feedback mechanisms including real-time electronic alerts to achieve near 100% timely prophylactic antibiotic administration in surgical cases.

Background: Administration of prophylactic antibiotics during surgery is generally performed by the anesthesia providers. Timely antibiotic administration within the optimal time window before incision is critical for prevention of surgical site infections. However, this often becomes a difficult task for the anesthesia team during the busy part of a case when the patient is being anesthetized.

Performance of a consensus scoring algorithm for assessing pediatric advanced life support competency using a computer screen-based simulator.

Objective: To develop a computer screen-based simulator that may be used as a pediatric advanced life support (PALS) cognitive skill assessment tool and to pilot test a consensus-based scoring system for the simulator.

Design: Development of an evaluation tool, followed by prospective, observational study of tool performance.

Setting: Tertiary care pediatric hospital.

Open-source shared case library.

Sharing simulator case scenarios among educators will greatly reduce the cost and effort involved in bringing simulation to our students. A library of 72 cases was posted to the internet to freely share. The cases in the library consist of text files utilizing a simple open-source format.

Symptom-based, algorithmic approach for handling the initial encounter with victims of a potential terrorist attack.

Objectives: This study intended to create symptom-based triage algorithms for the initial encounter with terror-attack victims. The goals of the triage algorithms include: (1) early recognition; (2) avoiding contamination; (3) early use of antidotes; (4) appropriate handling of unstable, contaminated victims; and (5) provisions of force protection. The algorithms also address industrial accidents and emerging infections, which have similar clinical presentations and risks for contamination as weapons of mass destruction (WMD).

Evaluation of anesthesia residents using mannequin-based simulation: a multiinstitutional study.

Background: Anesthesia simulators can generate reproducible, standardized clinical scenarios for instruction and evaluation purposes. Valid and reliable simulated scenarios and grading systems must be developed to use simulation for evaluation of anesthesia residents.

Methods: After obtaining Human Subjects approval at each of the 10 participating institutions, 99 anesthesia residents consented to be videotaped during their management of four simulated scenarios on MedSim or METI mannequin-based anesthesia simulators.