A Mobile Post Anesthesia Care Unit Order Reminder System Improves Timely Order Entry.

IF 3.5 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Journal of Medical Systems Pub Date : 2024-06-10 DOI:10.1007/s10916-024-02079-7
Jacob C Clifton, Holly B Ende, Chandramouli Rathnam, Robert E Freundlich, Warren S Sandberg, Jonathan P Wanderer
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Abstract

Transition to the postanesthesia care unit (PACU) requires timely order placement by anesthesia providers. Computerized ordering enables automated order reminder systems, but their value is not fully understood. We performed a single-center, retrospective cohort study to estimate the association between automated PACU order reminders and primary outcomes (1) on-time order placement and (2) the degree of delay in placement. As a secondary post-hoc analysis, we studied the association between late order placement and PACU outcomes. We included patients with a qualifying postprocedure order from January 1, 2019, to May 31, 2023. We excluded cases transferred directly to the ICU, whose anesthesia provider was involved in the pilot testing of the reminder system, or those with missing covariate data. Order reminder system usage was defined by the primary attending anesthesiologist's receipt of a push notification reminder on the day of surgery. We estimated the association between reminder system usage and timely order placement using a logistic regression. For patients with late orders, we performed a survival analysis of order placement. The significance level was 0.05. Patient (e.g., age, race), procedural (e.g., anesthesia duration), and provider-based (e.g., ordering privileges) variables were used as covariates within the analyses. Reminders were associated with 51% increased odds of order placement prior to PACU admission (Odds Ratio: 1.51; 95% Confidence Interval: 1.43, 1.58; p ≤ 0.001), reducing the incidence of late PACU orders from 17.5% to 12.6% (p ≤ 0.001). In patients with late orders, the reminders were associated with 10% quicker placement (Hazard Ratio: 1.10; 95% CI 1.05, 1.15; p < 0.001). On-time order placement was associated with decreased PACU duration (p < 0.001), decreased odds of peak PACU pain score (p < 0.001), and decreased odds of multiple administration of antiemetics (p = 0.02). An order reminder system was associated with an increase in order placement prior to PACU arrival and a reduction in delay in order placement after arrival.

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移动式麻醉后护理单元订单提醒系统提高了订单输入的及时性。
向麻醉后护理病房(PACU)过渡需要麻醉服务提供者及时下达医嘱。计算机化下单使自动下单提醒系统成为可能,但其价值尚不完全清楚。我们进行了一项单中心回顾性队列研究,以估计 PACU 自动下单提醒与主要结果(1)按时下单和(2)延迟下单程度之间的关系。作为次要的事后分析,我们研究了延迟下单与 PACU 结果之间的关联。我们纳入了 2019 年 1 月 1 日至 2023 年 5 月 31 日期间开具合格术后医嘱的患者。我们排除了直接转入重症监护室的病例、麻醉提供者参与了提醒系统试点测试的病例或协变量数据缺失的病例。订单提醒系统的使用是指主要主治麻醉医师在手术当天收到推送通知提醒。我们使用逻辑回归估算了提醒系统的使用与及时下单之间的关系。对于延迟下单的患者,我们对下单情况进行了生存分析。显著性水平为 0.05。患者(如年龄、种族)、手术过程(如麻醉持续时间)和医疗服务提供者(如下单权限)变量被用作分析中的协变量。提醒与在 PACU 入院前下达医嘱的几率增加 51% 相关(比值比:1.51;95% 置信区间:1.43, 1.58;p ≤ 0.001),将 PACU 迟下医嘱的发生率从 17.5% 降至 12.6%(p ≤ 0.001)。在延迟下达医嘱的患者中,提醒与加快 10%的置管速度相关(危险比:1.10;95% CI 1.05,1.15;P<0.001)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Medical Systems
Journal of Medical Systems 医学-卫生保健
CiteScore
11.60
自引率
1.90%
发文量
83
审稿时长
4.8 months
期刊介绍: Journal of Medical Systems provides a forum for the presentation and discussion of the increasingly extensive applications of new systems techniques and methods in hospital clinic and physician''s office administration; pathology radiology and pharmaceutical delivery systems; medical records storage and retrieval; and ancillary patient-support systems. The journal publishes informative articles essays and studies across the entire scale of medical systems from large hospital programs to novel small-scale medical services. Education is an integral part of this amalgamation of sciences and selected articles are published in this area. Since existing medical systems are constantly being modified to fit particular circumstances and to solve specific problems the journal includes a special section devoted to status reports on current installations.
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