Mediated Interruptions of Anaesthesia Providers using Predictions of Workload from Anaesthesia Information Management System Data

Abstract

Perioperative interruptions generated electronically from anaesthesia information management systems (AIMS) can provide useful feedback, but may adversely affect task performance if distractions occur at inopportune moments. Ideally such interruptions would occur only at times when their impact would be minimal. In this study of AIMS data, we evaluated the times of comments, drugs, fluids and periodic assessments (e.g. electrocardiogram diagnosis and train-of-four) to develop recommendations for the timing of interruptions during the intraoperative period. The 39,707 cases studied were divided into intervals between: 1) enter operating room; 2) induction; 3) intubation; 4) surgical incision; and 5) end surgery. Five-minute intervals of no documentation were determined for each case. The offsets from the start of each interval when >50% of ongoing cases had completed initial documentation were calculated (MIN50). The primary endpoint for each interval was the percentage of all cases still ongoing at MIN50. Results were that the intervals from entering the operating room to induction and from induction to intubation were unsuitable for interruptions confirming prior observational studies of anaesthesia workload. At least 13 minutes after surgical incision was the most suitable time for interruptions with 92% of cases still ongoing. Timing was minimally affected by the type of anaesthesia, surgical facility, surgical service, prone positioning or scheduled case duration. The implication of our results is that for mediated interruptions, waiting at least 13 minutes after the start of surgery is appropriate. Although we used AIMS data, operating room information system data is also suitable.

Strategies for Net Cost Reductions with the Expanded Role and Expertise of Anesthesiologists in the Perioperative Surgical Home

“…Such decision-making is based not simply on having displays showing data from the AIMS such as real-time usage 63-65 but displays with recommendations or displays and brief checklists. [66][67][68][69] Consequently, in our experience, achieving a cost reduction [32][33][34]37,38,42,[44][45][46] depends not only on having a knowledgeable 50 OR Medical Director and someone with an analytics background but also on the Director of Anesthesia Informatics. Many of the AIMS data used for this purpose are the basic signals (e.g., when there is pulse oximetry and heart rate monitoring in use in an OR, the OR is occupied by a patient).…”

Percentages of Cases in Operating Rooms of Sufficient Duration to Accommodate a 30-Minute Breast Milk Pumping Session by Anesthesia Residents or Nurse Anesthetists

“…Our anesthesia time is longer than the anesthesia-controlled time, as the latter excludes the period from the start of positioning and surgical draping until incision. We did that because our prior study showed that documentation and other events were completed in 50% of cases by 12 to 13 minutes after the start of the surgical procedure [ 7 ].…”

“…These steps are complete in 50% of cases 12 to 13 minutes after surgical incision, depending on the surgical procedure. Neither surgical time, neuraxial anesthesia, positioning, ambulatory surgery center, or specialty influenced the 12- to 13-minute duration [ 7 ]. Several extra minutes also are needed for the handoff to the relieving provider and for the trip to the lactation room, which may not be close to the surgical suite.…”

Technological advances in perioperative monitoring: Current concepts and clinical perspectives

“…A feared problem with its use may be increased malpractice exposure as some evanescent perioperative physiological changes and the artifactual data from the monitors may be misinterpreted in the event of unfavorable patient outcome. [ 27 28 ] Hence, although introduced almost 25 years ago, its use in clinical practice is still limited, due to which there is no evidence of improved patient outcome with its use.…”