A Visual Analytics Dashboard to Summarize Serial Anesthesia Records in Pediatric Radiation Treatment

Abstract

Background Young children who undergo radiation therapy may require general anesthesia to remain still during weeks of radiation sessions. On a typical day at our hospital, an anesthesia team will care for 10 patients in the radiation therapy suite, and each patient will have multiple prior anesthetic records. Daily review of prior anesthesia records is important to maintain anesthetic consistency and to identify potential improvement, yet our electronic health record (EHR) made such review time-consuming and cumbersome.

Objectives This article aims to design a visual analytics interface that simultaneously displays data from multiple anesthesia encounters to support clinical consistency in medications and airway management.

Methods Documentation from the EHR is available in the clinical data warehouse following daily backups. A visual analytics interface was built to aggregate important components of multiple anesthesia encounters in pediatric radiation oncology on a single screen. The application was embedded in the EHR's anesthesia module and updated daily.

Results Each anesthesia encounter was represented by a vertical line with the date at the bottom of the screen. Each vertical line was divided into sections corresponding to the medications, type of airway device, type of radiation oncology procedure, days between treatments, and recovery score and time. Information about the medications, airways, and procedures was shown with icon legends. This layout enabled users to quickly see the key components of multiple anesthetics and make inferences between, for example, the medications used and the recovery score.

Conclusion The dashboard provides a high-level summary of all radiation therapy anesthesia records for children receiving recurrent treatments. In this clinical scenario, it is desirable to replicate an optimal anesthetic approach for daily or near-daily treatments or adjust the anesthetic based on observed patterns.

Keywords

data warehousing - documentation - efficiency - electronic health records - workflow

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects. The study was reviewed by the Institutional Review Board of the Children's Hospital of Philadelphia and determined not to be human subjects research.

• References

• 1 McFadyen JG, Pelly N, Orr RJ. Sedation and anesthesia for the pediatric patient undergoing radiation therapy. Curr Opin Anaesthesiol 2011; 24 (04) 433-438
• 2 Vogel J, Both S, Kirk M. , et al. Proton therapy for pediatric head and neck malignancies. Pediatr Blood Cancer 2018; 65 (02) e26858
• 3 Chua P, Hill-Kayser C, Ahumada LM. , et al. Visual analytics dashboard to explore the relationship of unscheduled treatment interruptions and variations in airway management for children undergoing external beam radiation therapy. Pract Radiat Oncol 2017; 7 (05) e339-e344
• 4 Miller K, Capan M, Weldon D. , et al. The design of decisions: matching clinical decision support recommendations to Nielsen's design heuristics. Int J Med Inform 2018; 117: 19-25
• 5 Dowding D, Merrill JA. The development of heuristics for evaluation of dashboard visualizations. Appl Clin Inform 2018; 9 (03) 511-518
• 6 Ratwani RM, Savage E, Will A. , et al. A usability and safety analysis of electronic health records: a multi-center study. J Am Med Inform Assoc 2018; 25 (09) 1197-1201
• 7 Watcha MF, Ramirez-Ruiz M, White PF, Jones MB, Lagueruela RG, Terkonda RP. Perioperative effects of oral ketorolac and acetaminophen in children undergoing bilateral myringotomy. Can J Anaesth 1992; 39 (07) 649-654
• 8 Simpao AF, Ahumada LM, Gálvez JA, Rehman MA. A review of analytics and clinical informatics in health care. J Med Syst 2014; 38 (04) 45
• 9 Caban JJ, Gotz D. Visual analytics in healthcare--opportunities and research challenges. J Am Med Inform Assoc 2015; 22 (02) 260-262
• 10 Tscholl DW, Handschin L, Neubauer P. , et al. Using an animated patient avatar to improve perception of vital sign information by anaesthesia professionals. Br J Anaesth 2018; 121 (03) 662-671
• 11 Simpao AF, Ahumada LM, Larru Martinez B. , et al. Design and implementation of a visual analytics electronic antibiogram within an electronic health record system at a tertiary pediatric hospital. Appl Clin Inform 2018; 9 (01) 37-45
• 12 Sorbello A, Ripple A, Tonning J. , et al. Harnessing scientific literature reports for pharmacovigilance. Prototype software analytical tool development and usability testing. Appl Clin Inform 2017; 8 (01) 291-305
• 13 Karami M, Safdari R. From information management to information visualization: development of radiology dashboards. Appl Clin Inform 2016; 7 (02) 308-329
• 14 Feller DJ, Burgermaster M, Levine ME. , et al. A visual analytics approach for pattern-recognition in patient-generated data. J Am Med Inform Assoc 2018; 25 (10) 1366-1374
• 15 Dagliati A, Sacchi L, Tibollo V. , et al. A dashboard-based system for supporting diabetes care. J Am Med Inform Assoc 2018; 25 (05) 538-547
• 16 Zaydfudim V, Dossett LA, Starmer JM. , et al. Implementation of a real-time compliance dashboard to help reduce SICU ventilator-associated pneumonia with the ventilator bundle. Arch Surg 2009; 144 (07) 656-662
• 17 Dowding D, Randell R, Gardner P. , et al. Dashboards for improving patient care: review of the literature. Int J Med Inform 2015; 84 (02) 87-100
• 18 Nair BG, Gabel E, Hofer I, Schwid HA, Cannesson M. Intraoperative clinical decision support for anesthesia: a narrative review of available systems. Anesth Analg 2017; 124 (02) 603-617
• 19 Freundlich RE, Ehrenfeld JM. Anesthesia information management: clinical decision support. Curr Opin Anaesthesiol 2017; 30 (06) 705-709
• 20 Simpao AF, Tan JM, Lingappan AM, Gálvez JA, Morgan SE, Krall MA. A systematic review of near real-time and point-of-care clinical decision support in anesthesia information management systems. J Clin Monit Comput 2017; 31 (05) 885-894
• 21 Tremper KK, Mace JJ, Gombert JM, Tremper TT, Adams JF, Bagian JP. Design of a novel multifunction decision support display for anesthesia care: AlertWatch OR. BMC Anesthesiol 2018; 18 (01) 16
• 22 Gálvez JA, Ahumada L, Simpao AF. , et al. Visual analytical tool for evaluation of 10-year perioperative transfusion practice at a children's hospital. J Am Med Inform Assoc 2014; 21 (03) 529-534
• 23 Wanderer JP, Gruss CL, Ehrenfeld JM. Using visual analytics to determine the utilization of preoperative anesthesia assessment. Appl Clin Inform 2015; 6 (04) 629-637