J Clin Monit Comput - Near real-time notification of gaps in cuff blood pressure recordings for improved patient monitoring.

Tópicos

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Resumo

Blood pressure monitoring during anesthesia is an American Society of Anesthesiology standard. However, the anesthesia provider sometimes fails to engage the patient monitor to make periodic (generally every 3-5 min) measurements of Non-Invasive Blood Pressure (NIBP), which can lead to extended periods (>5 min) when blood pressure is not monitored. We describe a system to automatically detect such gaps in NIBP measurement and notify clinicians in real-time to initiate measurement. We applied a decision support system called the Smart Anesthesia Messenger (SAM) to notify the anesthesia provider if NIBP measurements have not been made in the last 7 min. Notification messages were generated only if direct arterial blood pressure was not being monitored. NIBP gaps were analyzed for 9 months before and after SAM notification was initiated (12,000 cases for each period). SAM notification was able to reduce the occurrence of extended NIBP gaps >15 min from 15.7 ? 4.5 to 6.7 ? 2.0 instances per 1,000 cases (p < 0.001). In addition, for extended gaps (>15 min) the mean gap duration declined from 23.1 ? 2.0 to 18.6 ? 1.1 min after SAM notification was initiated (p < 0.001). However, for 7-15 min gaps, SAM notification was not effective in reducing the occurrence. The maximum gap encountered before SAM was 64 min, while it was 27 min with SAM notification. Real-time notification using SAM is an effective way to reduce both the number of instances and the duration of inadvertent, extended (>15 min) gaps in blood pressure measurements in the operating room. However, the frequency of gaps <15 min could not be reduced using the current configuration of SAM.

Resumo Limpo

blood pressur monitor anesthesia american societi anesthesiolog standard howev anesthesia provid sometim fail engag patient monitor make period general everi min measur noninvas blood pressur nibp can lead extend period min blood pressur monitor describ system automat detect gap nibp measur notifi clinician realtim initi measur appli decis support system call smart anesthesia messeng sam notifi anesthesia provid nibp measur made last min notif messag generat direct arteri blood pressur monitor nibp gap analyz month sam notif initi case period sam notif abl reduc occurr extend nibp gap min instanc per case p addit extend gap min mean gap durat declin min sam notif initi p howev min gap sam notif effect reduc occurr maximum gap encount sam min min sam notif realtim notif use sam effect way reduc number instanc durat inadvert extend min gap blood pressur measur oper room howev frequenc gap min reduc use current configur sam

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