An Intraoperative Telemedicine Program to Improve Perioperative Quality Measures-Reference-Cited by-同舟云学术

An Intraoperative Telemedicine Program to Improve Perioperative Quality Measures

Published:2023-09-22 Issue:9 Volume:6 Page:e2332517
ISSN:2574-3805
Container-title:JAMA Network Open
language:en
Short-container-title:JAMA Netw Open

Author:

King Christopher R.¹,Gregory Stephen¹,Fritz Bradley A.¹,Budelier Thaddeus P.¹,Ben Abdallah Arbi¹,Kronzer Alex¹,Helsten Daniel L.¹,Torres Brian¹,McKinnon Sherry¹,Goswami Shreya¹,Mehta Divya¹,Higo Omokhaye¹,Kerby Paul¹,Henrichs Bernadette¹,Wildes Troy S.²,Politi Mary C.¹,Abraham Joanna¹³,Avidan Michael S.¹,Kannampallil Thomas¹³,Abdelhack Mohamed⁴,Aranake-Chrisinger Amrita⁴,Archer Aaron⁴,Arends Maureen⁴,Armstrong Emily⁴,Athiraman Umeshkumar⁴,Balasubramanian Sennaraj⁴,Bansal Anchal⁴,Battig Kara⁴,Benematti Danielle⁴,Benzinger George⁴,Bollini Mara⁴,Borle Anuradha⁴,Bottros Michael⁴,Boyle Walter⁴,Bozada Thomas⁴,Bradley Margaret⁴,BrandonUfert BrandonUfert⁴,Brown Christina⁴,Brown-Shpigel Jamie⁴,Burton Jamila⁴,Carmony Megan⁴,Cass Kathryn⁴,Cavallone Laura⁴,Chen Yunwei⁴,Chen Yixin⁴,Choi Han⁴,Coggin Marissa⁴,Cohen Zachary⁴,Critchlow Casey⁴,Davies Christopher⁴,Davis Christopher⁴,Demler-Barth Aaron⁴,Durk Ryan⁴,Eddins Daniel⁴,Eisenbath David⁴,Ellis Meredith⁴,Emmert Daniel⁴,Escallier Krisztina⁴,Exler Jane⁴,Fingerman Mitchell⁴,Fischbach Ellen⁴,Frasca Elizabeth⁴,Ge Michelle⁴,Gillihan Jason⁴,Goez Marie⁴,Goodwin Natasha⁴,Graetz Thomas⁴,Guffey Ryan⁴,Gupta Shelly⁴,Gurba Katharine⁴,Gutesa Kelsey⁴,Guthrie Tracey⁴,Hakim Michael⁴,Hantler Charles⁴,Haw Peter⁴,Heeger Hilary⁴,Herrera Erin⁴,Hincker Alex⁴,Hovis Robert⁴,Hubbard Gary⁴,Hueneke Rocco⁴,Ingram Mark⁴,Iqbal Zahid⁴,Ironstone Susan⁴,Jacobsen Kyle⁴,Jain Nisha⁴,Kadi Bassel⁴,Kangrga Ivan⁴,Karanikolas Menelaos⁴,Kinealy Bridget⁴,Kinworthy Mary⁴,Kirkpatrick Holly⁴,Kiveric Esad⁴,Knibb Andrea⁴,Knittel Justin⁴,Kokefer Andreas⁴,Koman Helga⁴,Kras Joseph⁴,Kraus Kristin⁴,Lakshminarasimhachar Anand⁴,Larese Joseph⁴,Lattanand Chakrapol⁴,Malshet Casarella Aparna⁴,Mathew Jonathan⁴,Maybrier Hannah⁴,McAvity Peter⁴,McClellan Alyssa⁴,McDowell Jacob⁴,McKenzie Heather⁴,Meng Alicia⁴,Mickle Angela⁴,Milbrandt Melissa⁴,Mohinder Singh Preet⁴,Mohrmann Alexander⁴,Monks David⁴,Montes de Oca Arianna⁴,Murray-Torres Teresa⁴,Najrabi Khatera⁴,Nowakowski Lauren⁴,Nwokeabia Ifeanyi⁴,Oberhaus Jordan⁴,Owusu-Bediako Ekua⁴,Park Daniel⁴,Patel Aamil⁴,Perez Sarah⁴,Phillips Caroline⁴,Potter David⁴,Pulley Debra⁴,Rangrass Govind⁴,Rao Janavi⁴,Rathor Rashmi⁴,Riordan Isabella⁴,Ritter Cameron⁴,Roller Evan⁴,Sabino Martha⁴,Sanzalone Matthew⁴,Sayfutdinova Elvira⁴,Schadler Craig⁴,Schappe Elizabeth⁴,Schatz Alexandra⁴,Sebastiani Anne⁴,Seiber Kimberly⁴,Sharma Anshuman⁴,Sillery Sarah⁴,Silver Kate⁴,Siraco Susan⁴,Somercik Melanie⁴,Sontha Pratyush⁴,Spencer James⁴,Spencer Erika⁴,Stevens Tracey⁴,Swaniker Jasmin⁴,Szabo Martha⁴,Terkonda Raghu⁴,Thai Carolyn⁴,Todorovic Marko⁴,Tolly Brian⁴,Trammel Emma⁴,Tripathi Sandhya⁴,Tseng Lisa⁴,Uding Bradley⁴,Upadhyayula Ravi⁴,Varaday Swarup⁴,Varnum William⁴,Wang Minna⁴,Watkins Sarah⁴,Willingham Mark⁴,Wise William⁴,Wolfe Rachel⁴,Wolfson Maxim⁴,Woodstock Hannah⁴,Wright Randy⁴,Yang Katie⁴,Yee Branden⁴,Yuan Jennifer⁴,Zanaboni Paul⁴,Zenga Jessica⁴,Zhang James⁴,Zheng Tianyang⁴,Zimick Nicholas⁴,Zwingelberg Joshua⁴,

Affiliation:

1. Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri

2. Department of Anesthesiology, University of Nebraska Medical Center, Omaha

3. Institute for Informatics, Washington University School of Medicine in St Louis, St Louis, Missouri

4. for the ACTFAST Study Group

Abstract

ImportanceTelemedicine for clinical decision support has been adopted in many health care settings, but its utility in improving intraoperative care has not been assessed.ObjectiveTo pilot the implementation of a real-time intraoperative telemedicine decision support program and evaluate whether it reduces postoperative hypothermia and hyperglycemia as well as other quality of care measures.Design, Setting, and ParticipantsThis single-center pilot randomized clinical trial (Anesthesiology Control Tower–Feedback Alerts to Supplement Treatments [ACTFAST-3]) was conducted from April 3, 2017, to June 30, 2019, at a large academic medical center in the US. A total of 26 254 adult surgical patients were randomized to receive either usual intraoperative care (control group; n = 12 980) or usual care augmented by telemedicine decision support (intervention group; n = 13 274). Data were initially analyzed from April 22 to May 19, 2021, with updates in November 2022 and February 2023.InterventionPatients received either usual care (medical direction from the anesthesia care team) or intraoperative anesthesia care monitored and augmented by decision support from the Anesthesiology Control Tower (ACT), a real-time, live telemedicine intervention. The ACT incorporated remote monitoring of operating rooms by a team of anesthesia clinicians with customized analysis software. The ACT reviewed alerts and electronic health record data to inform recommendations to operating room clinicians.Main Outcomes and MeasuresThe primary outcomes were avoidance of postoperative hypothermia (defined as the proportion of patients with a final recorded intraoperative core temperature &gt;36 °C) and hyperglycemia (defined as the proportion of patients with diabetes who had a blood glucose level ≤180 mg/dL on arrival to the postanesthesia recovery area). Secondary outcomes included intraoperative hypotension, temperature monitoring, timely antibiotic redosing, intraoperative glucose evaluation and management, neuromuscular blockade documentation, ventilator management, and volatile anesthetic overuse.ResultsAmong 26 254 participants, 13 393 (51.0%) were female and 20 169 (76.8%) were White, with a median (IQR) age of 60 (47-69) years. There was no treatment effect on avoidance of hyperglycemia (7445 of 8676 patients [85.8%] in the intervention group vs 7559 of 8815 [85.8%] in the control group; rate ratio [RR], 1.00; 95% CI, 0.99-1.01) or hypothermia (7602 of 11 447 patients [66.4%] in the intervention group vs 7783 of 11 672 [66.7.%] in the control group; RR, 1.00; 95% CI, 0.97-1.02). Intraoperative glucose measurement was more common among patients with diabetes in the intervention group (RR, 1.07; 95% CI, 1.01-1.15), but other secondary outcomes were not significantly different.Conclusions and RelevanceIn this randomized clinical trial, anesthesia care quality measures did not differ between groups, with high confidence in the findings. These results suggest that the intervention did not affect the targeted care practices. Further streamlining of clinical decision support and workflows may help the intraoperative telemedicine program achieve improvement in targeted clinical measures.Trial RegistrationClinicalTrials.gov Identifier: NCT02830126

Publisher

American Medical Association (AMA)

Subject

General Medicine

Link

https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2809789/king_2023_oi_230941_1694799059.20276.pdf

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