Electronic DS increases guidelines adherence for the prescription of PONV prophylaxis in high-risk PONV patients.

Editor's key points † Postoperative nausea and vomiting (PONV) is one of the main adverse outcomes leading to delayed discharge. † A range of guidelines are available that may reduce PONV, but are often not implemented. † This study assesses the use of an automated reminder system to improve compliance with guidelines. † PONV was reduced by automated reminders, particularly in high-risk patients.Background. Guidelines to minimize the incidence of postoperative nausea and vomiting (PONV) have been implemented in many hospitals. In previous studies, we have demonstrated that guideline adherence is suboptimal and can be improved using decision support (DS). In this study, we investigate whether DS improves patient outcome through improving physician behaviour.Methods. Medical information of surgical patients is routinely entered in our anaesthesia information management system (AIMS), which includes automated reminders for PONV management based on the simplified risk score by Apfel and colleagues. This study included consecutive adult patients undergoing general anaesthesia for elective noncardiac surgery who were treated according to the normal clinical routine. The presence of PONV was recorded in the AIMS both during the recovery period and at 24 h. Two periods were studied: one without the use of DS (control period) and one with the use of DS (support period). DS consisted of reminders on PONV both in the preoperative screening clinic and at the time of anaesthesia.Results. In the control period, 981 patients, of whom 378 (29%) were high-risk patients, received general anaesthesia. Overall, 264 (27%) patients experienced PONV within 24 h. In the support period, 1681 patients, of whom 525 (32%) had a high risk for PONV, received general anaesthesia. In this period, only 378 (23%) patients experienced PONV within 24 h after operation. This difference is statistically significant (P¼0.01).Conclusion. Automated reminders can improve patient outcome by improving guideline adherence.

Decision support is effective in improving administration and timing of PONV prophylaxis medication. After withdrawal of decision support, adherence decreased to predecision support levels.

In this study requesting a reason for non-adherence is associated with improved guideline adherence. The effect seems to depend on the underlying reason for non-adherence. It also illustrates the importance of human factors principles in the design of decision support. Some reasons for non-adherence may not be influenced by automated reminders.

No abstract