Appl Clin Inform 2022; 13(02): 370-379
DOI: 10.1055/s-0042-1744387
Research Article

Visualizing Opioid-Use Variation in a Pediatric Perioperative Dashboard

Conrad W. Safranek
1   Department of Biology: Computational Biology, Stanford University, Stanford, United States
,
Lauren Feitzinger
2   Department of Management Science and Engineering, Stanford University, Stanford, United States
,
Alice Kate Cummings Joyner
2   Department of Management Science and Engineering, Stanford University, Stanford, United States
,
Nicole Woo
2   Department of Management Science and Engineering, Stanford University, Stanford, United States
3   Department of Computer Science, Stanford University, Stanford, United States
,
Virgil Smith
2   Department of Management Science and Engineering, Stanford University, Stanford, United States
,
Elizabeth De Souza
4   Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States
,
Christos Vasilakis
5   Bath Centre for Healthcare Innovation and Improvement, School of Management, Centre for Healthcare Innovation and Improvement, University of Bath, Bath, United Kingdom
,
Thomas Anthony Anderson
4   Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States
,
James Fehr
4   Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States
,
Andrew Y. Shin
6   Department of Pediatrics—Cardiology, Stanford University School of Medicine, Stanford, California, United States
,
David Scheinker
2   Department of Management Science and Engineering, Stanford University, Stanford, United States
,
Ellen Wang
4   Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States
,
James Xie
4   Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States
› Author Affiliations
Funding Stanford University supplied a one-time research grant to Conrad Safranek during summer 2020 to continue development of the dashboard and to write a research manuscript. No other authors received any funding for this research.

Abstract

Background Anesthesiologists integrate numerous variables to determine an opioid dose that manages patient nociception and pain while minimizing adverse effects. Clinical dashboards that enable physicians to compare themselves to their peers can reduce unnecessary variation in patient care and improve outcomes. However, due to the complexity of anesthetic dosing decisions, comparative visualizations of opioid-use patterns are complicated by case-mix differences between providers.

Objectives This single-institution case study describes the development of a pediatric anesthesia dashboard and demonstrates how advanced computational techniques can facilitate nuanced normalization techniques, enabling meaningful comparisons of complex clinical data.

Methods We engaged perioperative-care stakeholders at a tertiary care pediatric hospital to determine patient and surgical variables relevant to anesthesia decision-making and to identify end-user requirements for an opioid-use visualization tool. Case data were extracted, aggregated, and standardized. We performed multivariable machine learning to identify and understand key variables. We integrated interview findings and computational algorithms into an interactive dashboard with normalized comparisons, followed by an iterative process of improvement and implementation.

Results The dashboard design process identified two mechanisms—interactive data filtration and machine-learning-based normalization—that enable rigorous monitoring of opioid utilization with meaningful case-mix adjustment. When deployed with real data encompassing 24,332 surgical cases, our dashboard identified both high and low opioid-use outliers with associated clinical outcomes data.

Conclusion A tool that gives anesthesiologists timely data on their practice patterns while adjusting for case-mix differences empowers physicians to track changes and variation in opioid administration over time. Such a tool can successfully trigger conversation amongst stakeholders in support of continuous improvement efforts. Clinical analytics dashboards can enable physicians to better understand their practice and provide motivation to change behavior, ultimately addressing unnecessary variation in high impact medication use and minimizing adverse effects.

Protection of Human and Animal Subjects

This quality improvement initiative was reviewed by Stanford's Research Compliance Office and exempted from formal IRB review.


Author Contributions

J.X. and C.S. drafted the initial manuscript. C.S., L.F., A.K.C.J., N.W., and V.S. were part of the original SURF project team that interviewed stakeholders, designed and iterated the visualization tool, and modeled the data under the intellectual guidance of C.V., A.Y.S., D.S. as the SURF course directors and J.F., T.A.A., E.W., and J.X. as the project sponsors and clinical content leads. E.D.S., E.W., and J.X. were responsible for clinical data extraction and validation. All authors C.S., L.F., A.K.C.J., N.W., V.S., E.D.S., C.V., T.A.A., J.F., A.Y.S., D.S., E.W., and J.X. participated in data interpretation, reviewed the manuscript critically for important intellectual content, and gave final approval of the version to be published.


Supplementary Material



Publication History

Received: 04 November 2021

Accepted: 27 January 2022

Publication Date:
23 March 2022 (online)

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