Documentation and Treatment of Intraoperative Hypotension: Electronic Anesthesia Records versus Paper Anesthesia Records

Abstract

In this study, we examined anesthetic records before and after the implementation of an electronic anesthetic record documentation (AIMS) in a single surgical population. The purpose of this study was to identify any inconsistencies in anesthetic care based on handwritten documentation (paper) or AIMS. We hypothesized that the type of anesthetic record (paper or AIMS) would lead to differences in the documentation and management of hypotension. Consecutive patients who underwent esophageal surgery between 2009 and 2014 by a single surgeon were eligible for the study. Patients were grouped in to 'paper' or 'AIMS' based on the type of anesthetic record identified in the chart. Pertinent patient identifiers were removed and data collated after collection. Predetermined preoperative and intraoperative data variables were reviewed. Consecutive esophageal surgery patients (N = 189) between 2009 and 2014 were evaluated. 92 patients had an anesthetic record documented on paper and 97 using AIMS. The median number of unique blood pressure recordings was lower in the AIMS group (median (Q1,Q3) AIMS 30.0 (24.0, 39.0) vs. Paper 35.0 (28.5, 43.5), p < 0.01). However, the median number of hypotensive events (HTEs) was higher in the AIMS group (median (Q1,Q3) 8.0 (4.0, 18.0) vs. 4.0 (1.0, 10.5), p < 0.001), and the percentage of HTEs per blood pressure recording was higher in the AIMS group (30.4 ((Q1, Q3) (9.5, 60.9)% vs. 12.5 (2.4, 27.5)%), p < 0.01). Multivariable regression analysis identified independent predictors of HTEs. The incidence of HTEs was found to increase with AIMS (IRR = 1.88, p < 0.01). Preoperative systolic blood pressure, increased blood loss, and phenylephrine. A phenylephrine infusion was negatively associated with hypotensive events (IRR = 0.99, p = 0.03). We noted an increased incidence of HTEs associated with the institution of an AIMS. Despite this increase, no change in medical therapy for hypotension was seen. AIMS did not appear to have an effect on the management of intraoperative hypotension in this patient population.

Manual Anesthesia Record Keeping at a Tertiary Care Center: A Descriptive Cross-sectional Study

“…12 According to new studies limitation of manual recording, can be over come by computerized record-keeping; as it has certain advantages like accurate record of intraoperative vital parameters, better quality of care and regulatory compliance. 13,14 This study has limitation as it was performed at one teaching hospital and does not reflect the practices at other hospitals. Our study does not include preoperative chart, which contains pre-anesthetic evaluation of the patient.…”

Usage of Anesthesia Information Management Systems in European Countries in 2020 – A Short Survey

“…First attempts to capture patient data electronically throughout anesthesia took place more than forty years ago [2]. AARKS decreases the workload of the anesthesiologist [3] and recorded data is more exact [4] since anesthesiologists tend to "smooth out" their manual records [5]. Even so, some information must be entered manually (e.g.…”

Pre‐operative hypertension and intra‐operative hypotension: a reply

“…However, this approach to recording patient blood pressure data in studies has been used in important global studies that have and continue to define our understanding of adverse outcomes associated with peri‐operative hypotension . Interestingly, although the introduction of electronic record keeping has shown to increase the number of identified hypotensive episodes (as would be expected ), it did not increase the rate of hypotensive interventions . It is also important to note, that in our normal clinical practice, anaesthetists do not readily accept a MAP as low as 55 mmHg.…”