Appl Clin Inform 2014; 05(03): 630-641
DOI: 10.4338/ACI-2014-02-RA-0015
Research Article
Schattauer GmbH

Information needs for the OR and PACU electronic medical record

V. Herasevich
1   Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN
2   Multidisciplinary Epidemiology and Translation Research in Intensive Care (METRIC), Mayo Clinic College of Medicine, Rochester, MN
,
M.A. Ellsworth
3   Division of Neonatal Medicine, Mayo Clinic College of Medicine, Rochester, MN
,
J.R. Hebl
1   Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN
,
M.J. Brown
1   Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN
,
B.W. Pickering
1   Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN
2   Multidisciplinary Epidemiology and Translation Research in Intensive Care (METRIC), Mayo Clinic College of Medicine, Rochester, MN
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received: 03. März 2014

accepted: 01. Juni 2014

Publikationsdatum:
19. Dezember 2017 (online)

Summary

Objective: The amount of clinical information that anesthesia providers encounter creates an environment for information overload and medical error. In an effort to create more efficient OR and PACU EMR viewer platforms, we aimed to better understand the intraoperative and post-anesthesia clinical information needs among anesthesia providers.

Materials and Methods: A web-based survey to evaluate 75 clinical data items was created and distributed to all anesthesia providers at our institution. Participants were asked to rate the importance of each data item in helping them make routine clinical decisions in the OR and PACU settings.

Results: There were 107 survey responses with distribution throughout all clinical roles. 84% of the data items fell within the top 2 proportional quarters in the OR setting compared to only 65% in the PACU. Thirty of the 75 items (40%) received an absolutely necessary rating by more than half of the respondents for the OR setting as opposed to only 19 of the 75 items (25%) in the PACU. Only 1 item was rated by more than 20% of respondents as not needed in the OR compared to 20 data items (27%) in the PACU.

Conclusion: Anesthesia providers demonstrate a larger need for EMR data to help guide clinical decision making in the OR as compared to the PACU. When creating EMR platforms for these settings it is important to understand and include data items providers deem the most clinically useful. Minimizing the less relevant data items helps prevent information overload and reduces the risk for medical error.

Citation: Herasevich V, Ellsworth MA, Hebl JR, Brown MJ, Pickering BW. Information needs for the OR and PACU electronic medical record. Appl Clin Inf 2014; 5: 630–641

http://dx.doi.org/10.4338/ACI-2014-02-RA-0015

 
  • References

  • 1 Manor-Shulman O, Beyene J, Frndova H, Parshuram CS. Quantifying the volume of documented clinical information in critical illness. J Crit Care 2008; 23 (02) 245-250.
  • 2 Driscoll WD, Columbia MA, Peterfreund RA. An observational study of anesthesia record completeness using an anesthesia information management system. Anesth Analg 2007; 104 (06) 1454-1461.
  • 3 Potter AK, Johnson DP. Extracting the pertinent from the irrelevant. Minn Med 1994; 77 (04) 58.
  • 4 Ahmed A, Chandra S, Herasevich V, Gajic O, Pickering BW. The effect of two different electronic health record user interfaces on intensive care provider task load, errors of cognition, and performance. Crit Care Med 2011; 39 (07) 1626-1634.
  • 5 Pickering BW, Hurley K, Marsh B. Identification of patient information corruption in the intensive care unit: using a scoring tool to direct quality improvements in handover. Crit Care Med 2009; 37 (11) 2905-2912.
  • 6 Institute of Medicine CoQoHCiA.. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999
  • 7 Randa K. Using IT to drive operational efficiency in the OR. Healthc Financ Manage 2010; 64 (12) 90-92 94.
  • 8 Foglia RP, Alder AC, Ruiz G. Improving perioperative performance: the use of operations management and the electronic health record. J Pediatr Surg 2013; 48 (01) 95-98.
  • 9 Ellner SJ, Joyner PW. Information technologies and patient safety. Surg Clin North Am 2012; 92 (01) 79-87.
  • 10 Blike GT, Surgenor SD, Whalen K. A graphical object display improves anesthesiologists’ performance on a simulated diagnostic task. J Clin Monit Comput 1999; 15 (01) 37-44.
  • 11 Blike GT, Surgenor SD, Whalen K, Jensen J. Specific elements of a new hemodynamics display improves the performance of anesthesiologists. J Clin Monit Comput 2000; 16 (07) 485-491.
  • 12 Charabati S, Bracco D, Mathieu PA, Hemmerling TM. Comparison of four different display designs of a novel anaesthetic monitoring system, the ’integrated monitor of anaesthesia (IMA)’. Br J Anaesth 2009; 103 (05) 670-677.
  • 13 Wachter SB, Johnson K, Albert R, Syroid N, Drews F, Westenskow D. The evaluation of a pulmonary display to detect adverse respiratory events using high resolution human simulator. J Am Med Inform Assoc 2006; 13 (06) 635-642.
  • 14 Wachter SB, Markewitz B, Rose R, Westenskow D. Evaluation of a pulmonary graphical display in the medical intensive care unit: an observational study. J Biomed Inform 2005; 38 (03) 239-243.
  • 15 Ehrenfeld JM, Rehman MA. Anesthesia information management systems: a review of functionality and installation considerations. J Clin Monit Comput 2011; 25 (01) 71-79.
  • 16 Stol IS, Ehrenfeld JM, Epstein RH. Technology diffusion of anesthesia information management systems into academic anesthesia departments in the United States. Anesth Analg 2014; 118 (03) 644-650.
  • 17 Spring SF, Sandberg WS, Anupama S, Walsh JL, Driscoll WD, Raines DE. Automated documentation error detection and notification improves anesthesia billing performance. Anesthesiology 2007; 106 (01) 157-163.
  • 18 Egger Halbeis CB, Epstein RH, Macario A, Pearl RG, Grunwald Z. Adoption of anesthesia information management systems by academic departments in the United States. Anesth Analg 2008; 107 (04) 1323-1329.
  • 19 Trentman TL, Mueller JT, Ruskin KJ, Noble BN, Doyle CA. Adoption of anesthesia information management systems by US anesthesiologists. J Clin Monit Comput 2011; 25 (02) 129-135.
  • 20 Jamoom E, Beatty P, Bercovitz A, Woodwell D, Palso K, Rechtsteiner E. Physician adoption of electronic health record systems: United States, 2011. NCHS Data Brief 2012; 98: 1-8.
  • 21 Rothman B, Sandberg WS, St Jacques P. Using information technology to improve quality in the OR. Anesthesiol Clin 2011; Mar 29 (Suppl. 01) 29-55.
  • 22 Stabile M, Cooper L. Review article: the evolving role of information technology in perioperative patient safety. Can J Anaesth 2010; 60 (02) 119-126.
  • 23 Pickering BW, Gajic O, Ahmed A, Herasevich V, Keegan MT. Data utilization for medical decision making at the time of patient admission to ICU. Crit Care Med 2013; 41 (06) 1502-1510.
  • 24 Pickering BW, Herasevich V, Ahmed A, Gajic O. Novel Representation of Clinical Information in the ICU: Developing User Interfaces which Reduce Information Overload. Appl Clin Inform 2010; 1 (02) 116-131.
  • 25 Frassica JJ. CIS: where are we going and what should we demand from industry?. J Crit Care 2004; 19 (04) 226-233.
  • 26 Carpenter PC. The electronic medical record: perspective from Mayo Clinic. Int J Biomed Comput 1994; 34 1–4 159-171.
  • 27 Haugen AS, Murugesh S, Haaverstad R, Eide GE, Softeland E. A survey of surgical team members’ perceptions of near misses and attitudes towards Time Out protocols. BMC Surg 2013; 13: 46.
  • 28 Dexter F, Logvinov II, Brull SJ. Anesthesiology residents’ and nurse anesthetists’ perceptions of effective clinical faculty supervision by anesthesiologists. Anesth Analg 2013; 116 (06) 1352-1355.
  • 29 Elisha S, Rutledge DN. Clinical education experiences: perceptions of student registered nurse anesthetists. AANA J 2011; 79 4 Suppl. S35-S42.
  • 30 Meno KM, Keaveny BM, O’Donnell JM. Mentoring in the operating room: a student perspective. AANA J 2003; 71 (05) 337-341.
  • 31 Mills P, Neily J, Dunn E. Teamwork and communication in surgical teams: implications for patient safety. J Am Coll Surg 2008; 206 (01) 107-112.
  • 32 Nagpal K, Vats A, Lamb B, Ashrafian H, Sevdalis N, Vincent C, Moorthy K. Information transfer and communication in surgery: a systematic review. Ann Surg 2010; 252 (02) 225-239.
  • 33 Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, Bohnen J, Orser B, Doran D, Grober E. Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care 2004; 13 (05) 330-334.
  • 34 Wong HW, Forrest D, Healey A, Shirafkan H, Hanna GB, Vincent CA, Sevdalis N. Information needs in operating room teams: what is right, what is wrong, and what is needed?. Surg Endosc 2011; 25 (06) 1913-1920.
  • 35 Anwari JS. Quality of handover to the postanaesthesia care unit nurse. Anaesthesia 2002; 57 (05) 488-493.
  • 36 Rikli J, Huizinga B, Schafer D, Atwater A, Coker K, Sikora C. Implementation of an electronic documentation system using microsystem and quality improvement concepts. Adv Neonatal Care 2009; 9 (02) 53-60.
  • 37 Gocsik T. Last man standing? Advice for engaging anesthesia clinicians when implementing an EMR in anesthesiology services. Healthc Inform 2012; 29 (10) 32 7.
  • 38 Schreiber R, MacDonald M. A closer look at the „supervision“ and „direction“ of certified registered nurse anesthetists. Can Nurse 2008; 104 (03) 28-33.
  • 39 Matsusaki T, Sakai T. The role of Certified Registered Nurse Anesthetists in the United States. J Anesth 2011; 25 (05) 734-740.