Perioperative Connection:
A Look at the Computerized Anesthesia Record
Jason Hemmerich, M.D.
nesthesiology has been one of the late adopters of
information technology to streamline work flow. Over
the years, the anesthesiologist’s role has grown
beyond intraoperative patient care to a broader perioperative
management of the patient. Electronic anesthesia records
were developed to enable more efficient use of time,
personnel and resources in the operating room and
beyond in hopes of minimizing costs and optimizing
patient care. Our education stands to benefit from
such endeavors.
The Centricity system at the University of Michigan
in Ann Arbor is one of the first such large-scale
computerized anesthesia records <www.med.umich.edu/anes/sections/morcare/default.htm>.
Composed of Ethernet-connected monitors at each location,
Centricity interfaces and displays information from
multiple physiologic monitors, automatically collecting
data such as hemodynamics, capnography, anesthetic
gas analyses, oxygen saturation and ventilator settings.
In addition the system database lists every fluid
and medication with appropriate doses, common procedures,
interventions and observations. The provider charts
routine aspects of anesthesia, such as induction and
emergence, utilizing touch-sensitive screens. The
system is preprogrammed with default settings in order
to speed documentation of these complex procedures.
Centricity’s computerized anesthesia record
renders vital signs in real-time color graphs and
can incorporate information from preoperative care,
intraoperative procedural data, postoperative care
and quality assurance. It can access multiple medical
databases covering topics such as drug profiles, common
disease states and medical journals, thus enabling
the physician to obtain information quickly. The record
can then be reviewed and printed out on paper.
The computerized anesthesia record plays an important
role in academic facilities. It allows for computer-assisted
teaching and instruction at all levels of training.
The attending physician can monitor live data and
review the anesthesia record of multiple patients
from outside the operating room while the resident
is with the patient. The computerized anesthesia record
simplifies requirements of the Accreditation Council
for Graduate Medical Education by storing all cases
in a central database. Individual resident operating
room assignments can be tailored to each resident’s
need for specific types of cases. In addition faculty
and resident evaluations are more accessible and are
performed in a timely fashion, resulting in an increased
number of completed evaluations. This feedback is
essential to a resident’s growth.
The preoperative evaluation is impossible without
adequate access to the information known about the
patient from other medical documents. Systems like
this one allow the user to gather information from
existing computerized sources such as subspecialty
documents, imaging, test results and laboratory values.
These systems not only create efficient documentation
of the preoperative evaluation but also improve the
distribution of appropriate information between multiple
providers. Important information can be automatically
duplicated in each preoperative evaluation, allowing
for recognition of conditions such as malignant hyperthermia,
allergies or a recent difficult airway and subsequently
alert the physician of this critical information.
The storage of anesthesia records in a database allows
for rapid and easy retrieval of a patient’s
previous anesthesia records.
Although these systems are initially very expensive,
there are many benefits to integrating them. One of
the major advantages of the computerized record is
that it allows more time for direct patient care and
learning. Rapid access to vital information in anesthesiology
can mean the difference between a successful intervention
and a disaster. It also creates time for important
communication with colleagues and observation of the
surgical field and allows for greater development
of evidence-based medicine. It is simple for the researcher
to generate data on multiple parameters with an incredible
number of patients, allowing for an easy review of
similar patient situations to help determine expected
lengths of stay, costs and rates of complications.
Multiple studies have demonstrated that the output
of these systems is more accurate, complete and legible
than handwritten records. These documents also have
proven to be more useful during litigation.
The teaching and practice of anesthesiology will greatly
benefit from assimilating the advantages of the modern
communication age.
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Jason
Hemmerich, M.D., is a CA-2 resident at the University
of Michigan, Ann Arbor, Michigan. |
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