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February 4, 2019

Summary: Despite some potential pitfalls, health information technology can be used to improve anesthesia quality in a multitude of ways. In a follow-up to last week’s eAlert, we provide additional examples from a presentation on the use of HIT in anesthesia at PRACTICE MANAGEMENT™ 2019.

In last week’s eAlert, we discussed some of the ways that health information technology (HIT) can be harnessed to improve quality in anesthesia. With proper implementation and vigilance in the face of the added distractions that can come with automation, HIT can help drive improvements in documentation, clinical decision-making, financial performance, clinician satisfaction and much more.

This eAlert reviews additional examples of HIT’s successful use in anesthesia quality improvement from the presentation by Mark A. Deshur, MD, MBA, of NorthShore University HealthSystem, at the ASA’s PRACTICE MANAGEMENT™ 2019 in Las Vegas.

Manage use of blood products.  Anesthesiologists at Johns Hopkins Medical Institutions analyzed AIMS blood utilization data for approximately 53,000 patients who underwent 1,600 different types of procedures at the health system to develop an updated maximum surgical blood order schedule (MSBOS) for each specialty.  They used an algorithm that divided surgical procedures into categories based on blood loss and the need for blood products.

Retroactively applying the new algorithm to the 53,000 cases, they found that 27,000 of the cases did not require any preoperative blood orders; however, of those cases, 32.7 percent had a type and screen and 9.5 percent had a crossmatch ordered.  Using the MSBOS to eliminate the unnecessary blood orders, they calculated a potential savings of $211,000 in hospital charges and $43,000 in actual costs.  Since then, Johns Hopkins Medical Institutions has implemented a system-wide blood management program that has yielded more than $2 million in savings.

Increase medication safety with smart labeling.  Dr. Deshur said that smart labeling systems have been shown to greatly reduce serious medication errors.  Barcode-assisted syringe labeling systems, for example, allow providers to scan the manufacturer’s barcode on a vial before drug preparation, print a Joint Commission-compliant syringe label that includes the barcode, drug concentration and other pertinent information, and scan the syringe label barcode immediately before administering the drug to the patient.  To support accuracy, some systems provide visual and audio read-back of the drug name and concentration when the label is scanned.

[A 2016 Anesthesiology study found that one in 20 perioperative medication administrations involved a medication error and/or an adverse drug event.  The study suggested that barcode-assisted syringe labeling systems have potential to eliminate labeling errors, and that point-of-care barcode-assisted documentation systems that allow providers to scan the syringe label immediately before administration and populate the AIMS may help reduce documentation errors as well.]

Streamline professional practice evaluations.  Dr. Deshur’s institution leveraged its anesthesia staff scheduling software to automate the professional practice evaluations mandated annually by the Joint Commission.  The scheduling system includes pop-up screens that list all of the clinicians who have worked with a given physician or nurse anesthetist during the year.  An evaluation form can be sent to each of the clinicians who have worked with a provider by simply clicking on their name.

Completed evaluations are indicated on the screen in green; red shows that the evaluation has not yet been submitted.  “We took an onerous process, automated it and made it simple,” said Dr. Deshur.  Before the project, “one of the biggest complaints was ‘this person’s evaluating me and I’ve never worked with them.’ Now we’re getting real feedback that matters.”  

Optimize staff scheduling.  The dashboard of NorthShore University HealthSystem’s anesthesia staff scheduling system uses an algorithm based on historical averages and numbers of people scheduled to work on given days to predict, and indicate by color, days of the month when staffing will be sufficient (green), tight but workable (yellow), and insufficient (pink) in the hospitals’ operating rooms.

“Staff see days they are not scheduled to work where we need help, or days they are scheduled to work where maybe we have a few extra people and they can take that day off,” Dr. Deshur explained. “It gives people an opportunity to switch days and put their name on a volunteer calendar or pick up an extra shift, take a vacation day, come in a little early or stay a little late.”  The staffing dashboard “increases our flexibility and helps us match our demand for services with our supply of staff.”

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