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Published in: BMC Anesthesiology 1/2018

Open Access 01-12-2018 | Software

Design of a Novel Multifunction Decision Support Display for Anesthesia Care: AlertWatch® OR

Authors: Kevin K. Tremper, Jenny J. Mace, Jan M. Gombert, Theodore T. Tremper, Justin F. Adams, James P. Bagian

Published in: BMC Anesthesiology | Issue 1/2018

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Abstract

Background

This paper describes the design of a multifunction alerting display for intraoperative anesthetic care. The design was inspired by the multifunction primary flight display used in modern aviation.

Results

The display retrieves live data from multiple sources; the physiologic monitors, the anesthesia information management system, the laboratory values and comorbidities from patient’s problem summary list, medical history or history & physical. This information is integrated into a display composed of readily identifiable icons of organ systems, which are color coded to signify normal range, marginal range, abnormal range (by green, yellow, red respectively) and orange outlines for comorbidities/risk factors. There are dozens of text alerts, which can be presented as black text (informational), red text (important information) and red scrolling text (highest importance information). The alerts are derived from current standards in the literature and some involve complex calculations being conducted in the background.

Conclusions

The goal of such a system is to improve the quality and safety of anesthetic care by providing enhanced situational awareness in a fashion analogous to the “glass cockpit” and its primary flight display which has improved aviation safety.
Appendix
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Literature
4.
go back to reference Neily J, Mills PD, Young-Xu Y, et al. Association between implementation of a medical team training program and surgical mortality. JAMA. 2010;304(15):1693–700.CrossRefPubMed Neily J, Mills PD, Young-Xu Y, et al. Association between implementation of a medical team training program and surgical mortality. JAMA. 2010;304(15):1693–700.CrossRefPubMed
5.
go back to reference Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491–9.CrossRefPubMed Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491–9.CrossRefPubMed
6.
go back to reference Kheterpal S, O’Reilly M, Englesbe MJ, et al. Preoperative and intraoperative predictors of cardiac adverse events after general, vascular, and urological surgery. Anesthesiology. 2009;110:58–66.CrossRefPubMed Kheterpal S, O’Reilly M, Englesbe MJ, et al. Preoperative and intraoperative predictors of cardiac adverse events after general, vascular, and urological surgery. Anesthesiology. 2009;110:58–66.CrossRefPubMed
7.
go back to reference Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, Cywinski J, Thabane L, Sessler DI. Relationship between Intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery. Anesthesiology. 2013;119:507–15.CrossRefPubMed Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, Cywinski J, Thabane L, Sessler DI. Relationship between Intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery. Anesthesiology. 2013;119:507–15.CrossRefPubMed
8.
go back to reference Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal volume ventilation in abdominal surgery. N Engl J Med. 2013;369:428–37.CrossRefPubMed Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal volume ventilation in abdominal surgery. N Engl J Med. 2013;369:428–37.CrossRefPubMed
9.
go back to reference Monk TG, Bronsert MR, Henderson WG, Mangione MP, STJ S-P, Bentt DR, Nguyen JD, Richman JS, Meguid RA, Hammermeister KE. Association between Intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery. Anesthesiology. 2015;123:307–19.CrossRefPubMed Monk TG, Bronsert MR, Henderson WG, Mangione MP, STJ S-P, Bentt DR, Nguyen JD, Richman JS, Meguid RA, Hammermeister KE. Association between Intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery. Anesthesiology. 2015;123:307–19.CrossRefPubMed
10.
go back to reference Sun LY, Wijeysundera DN, Tait GA, Beattie WS. Association of Intraoperative Hypotension with acute kidney injury after elective noncardiac surgery. Anesthesiology. 2015;123:515–23.CrossRefPubMed Sun LY, Wijeysundera DN, Tait GA, Beattie WS. Association of Intraoperative Hypotension with acute kidney injury after elective noncardiac surgery. Anesthesiology. 2015;123:515–23.CrossRefPubMed
11.
go back to reference van Waes, JA et al Association between Intraoperative hypotension and myocardial injury after vascular surgery Anesthesiology 2016, V 124, No 1 p 35-44. van Waes, JA et al Association between Intraoperative hypotension and myocardial injury after vascular surgery Anesthesiology 2016, V 124, No 1 p 35-44.
12.
go back to reference Kotagal M, Symons RG, Hirsch IB, Umpierrez GE, Dellinger EP, Farrokhi ET, Flum DR, (CHASE Alliance). Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Ann Surg 2015; 261(1):97-103.CrossRefPubMedPubMedCentral Kotagal M, Symons RG, Hirsch IB, Umpierrez GE, Dellinger EP, Farrokhi ET, Flum DR, (CHASE Alliance). Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Ann Surg 2015; 261(1):97-103.CrossRefPubMedPubMedCentral
13.
go back to reference Chappell D, Jacob M, Hofmann-Kiefer K, et al. A rational approach to perioperative fluid management. Anesthesiology. 2008;109:723–40.CrossRefPubMed Chappell D, Jacob M, Hofmann-Kiefer K, et al. A rational approach to perioperative fluid management. Anesthesiology. 2008;109:723–40.CrossRefPubMed
14.
go back to reference Kheterpal S, Shanks A, Tremper KK. Impact of a Novel Multiparameter Decision Support System on Intraoperative Processes of Care and Postoperative Outcomes. Anesthesiology 2018; 128:272–82. Kheterpal S, Shanks A, Tremper KK. Impact of a Novel Multiparameter Decision Support System on Intraoperative Processes of Care and Postoperative Outcomes. Anesthesiology 2018; 128:272–82.
15.
go back to reference Tremper KK. Anesthesiology: from patient safety to population outcomes. The 49th annual Rovenstine lecture. Anesthesiology. 2011;114:755–70.CrossRefPubMed Tremper KK. Anesthesiology: from patient safety to population outcomes. The 49th annual Rovenstine lecture. Anesthesiology. 2011;114:755–70.CrossRefPubMed
16.
go back to reference Sathishkumar S, Lai M, Picton P, Kheterpal S, Morris M, Shanks A, Ramachandran SK. Behavioral modification of Intraoperative hyperglycemia management with a novel real-time audiovisual monitor. Anesthesiology. 2015;123:29–37.CrossRefPubMed Sathishkumar S, Lai M, Picton P, Kheterpal S, Morris M, Shanks A, Ramachandran SK. Behavioral modification of Intraoperative hyperglycemia management with a novel real-time audiovisual monitor. Anesthesiology. 2015;123:29–37.CrossRefPubMed
19.
go back to reference Robinson JD, Lupkiewicz SM, Palenik L, Lopez LM, Ariet M. Determination of ideal body weight for drug dosage calculations. Am J Health Syst Pharm. 1983;40(6):1016–9. Robinson JD, Lupkiewicz SM, Palenik L, Lopez LM, Ariet M. Determination of ideal body weight for drug dosage calculations. Am J Health Syst Pharm. 1983;40(6):1016–9.
20.
go back to reference Nadler S, Hidalgo J, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;51:224–32.PubMed Nadler S, Hidalgo J, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;51:224–32.PubMed
21.
go back to reference Cortes DO, Barros TG, Njimi H, Vincent JL. Crystalloids versus colloids: exploring differences in fluid requirements by systematic review and meta-regression. Anesth Analg. 2015;120:389–402.CrossRef Cortes DO, Barros TG, Njimi H, Vincent JL. Crystalloids versus colloids: exploring differences in fluid requirements by systematic review and meta-regression. Anesth Analg. 2015;120:389–402.CrossRef
22.
go back to reference Kaye AD. Fluid Management, Chapter 23. In: Miller RD, Pardo Jr MC, editors. Basics of anesthesia. 6th ed. Philadelphia, PA: Elsevier Saunders; 2011. p. 364–71.CrossRef Kaye AD. Fluid Management, Chapter 23. In: Miller RD, Pardo Jr MC, editors. Basics of anesthesia. 6th ed. Philadelphia, PA: Elsevier Saunders; 2011. p. 364–71.CrossRef
23.
go back to reference Mashour GA, Esaki RK, Vendervest JC, Shanks A, Kheterpal S. A novel electronic algorithm for detecting potentially insufficient anesthesia: implications for the prevention of intraoperative awareness. J Clin Monit Comput. 2009;23:273–7.CrossRefPubMed Mashour GA, Esaki RK, Vendervest JC, Shanks A, Kheterpal S. A novel electronic algorithm for detecting potentially insufficient anesthesia: implications for the prevention of intraoperative awareness. J Clin Monit Comput. 2009;23:273–7.CrossRefPubMed
24.
go back to reference Mashour GA, Shanks A, Tremper KK, Kheterpal S, Turner CR. Prevention of intraoperative awareness with explicit recall in an unselected surgical population. Anesthesiology. 2012;117:717–25.CrossRefPubMedPubMedCentral Mashour GA, Shanks A, Tremper KK, Kheterpal S, Turner CR. Prevention of intraoperative awareness with explicit recall in an unselected surgical population. Anesthesiology. 2012;117:717–25.CrossRefPubMedPubMedCentral
25.
go back to reference Kheterpal S, Han R, Tremper KK, Shanks A, Tait AR, O’Reilly M, Ludwig T. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology. 2006;105:885–91.CrossRefPubMed Kheterpal S, Han R, Tremper KK, Shanks A, Tait AR, O’Reilly M, Ludwig T. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology. 2006;105:885–91.CrossRefPubMed
26.
go back to reference Kheterpal S, Healy D, Aziz M, et al. Incidence, predictors and outcome of difficult mask ventilation combined with difficult Laryngoscopy. Anesthesiology 2013; 119:1360-1369. Kheterpal S, Healy D, Aziz M, et al. Incidence, predictors and outcome of difficult mask ventilation combined with difficult Laryngoscopy. Anesthesiology 2013; 119:1360-1369.
27.
go back to reference Arriaga AF, Bader AM, Wong JM, et al. Simulation-based trial of surgical-crisis checklists. N Engl J Med. 2013;368:246–53.CrossRefPubMed Arriaga AF, Bader AM, Wong JM, et al. Simulation-based trial of surgical-crisis checklists. N Engl J Med. 2013;368:246–53.CrossRefPubMed
28.
go back to reference Pediatric Difficult Airway Protocol in PediCrisis Critical Event Cards, Society for Pediatric Anesthesia, revised November 19, 2014. Pediatric Difficult Airway Protocol in PediCrisis Critical Event Cards, Society for Pediatric Anesthesia, revised November 19, 2014.
29.
go back to reference Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9.CrossRefPubMed Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9.CrossRefPubMed
31.
go back to reference Feldman JM, Roth JV, Bjoraker DG. Maximum blood savings by acute Normovolemic Hemodilution. Anesth Analg. 1995;80:108–13.PubMed Feldman JM, Roth JV, Bjoraker DG. Maximum blood savings by acute Normovolemic Hemodilution. Anesth Analg. 1995;80:108–13.PubMed
32.
go back to reference Adult Blood Transfusion Clinical Guidelines, University of Michigan Hospitals and Health Centers. Approved by the UMHHC Executive Committee for Clinical Affairs on March 24, 2009. Adult Blood Transfusion Clinical Guidelines, University of Michigan Hospitals and Health Centers. Approved by the UMHHC Executive Committee for Clinical Affairs on March 24, 2009.
34.
go back to reference Bonafide CP, Lin R, Zander M, Graham CS, Paine CW, Rock W, Rich A, Roberts KE, Fortino M, Nadkarni VM, Localio AR, Keren R. Association between exposure to nonactionable physiologic monitor alarms and response time in a children's hospital. J Hosp Med. 2015;10:345–51.CrossRefPubMedPubMedCentral Bonafide CP, Lin R, Zander M, Graham CS, Paine CW, Rock W, Rich A, Roberts KE, Fortino M, Nadkarni VM, Localio AR, Keren R. Association between exposure to nonactionable physiologic monitor alarms and response time in a children's hospital. J Hosp Med. 2015;10:345–51.CrossRefPubMedPubMedCentral
Metadata
Title
Design of a Novel Multifunction Decision Support Display for Anesthesia Care: AlertWatch® OR
Authors
Kevin K. Tremper
Jenny J. Mace
Jan M. Gombert
Theodore T. Tremper
Justin F. Adams
James P. Bagian
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2018
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-018-0478-8

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