title: Feedback mechanisms including real-time electronic alerts to achieve near 100% timely prophylactic antibiotic administration in surgical cases.
abstract: BACKGROUND
  Administration of prophylactic antibiotics during surgery is generally performed by the anesthesia providers. Timely antibiotic administration within the optimal time window before incision is critical for prevention of surgical site infections. However, this often becomes a difficult task for the anesthesia team during the busy part of a case when the patient is being anesthetized.
  
  
  METHODS
  Starting with the implementation of an anesthesia information management system (AIMS), we designed and implemented several feedback mechanisms to improve compliance of proper antibiotic delivery and documentation. This included generating e-mail feedback of missed documentation, distributing monthly summary reports, and generating real-time electronic alerts with a decision support system.
  
  
  RESULTS
  In 20,974 surgical cases for the period, June 2008 to January 2010, the interventions of AIMS install, e-mail feedback, summary reports, and real-time alerts changed antibiotic compliance by -1.5%, 2.3%, 4.9%, and 9.3%, respectively, when compared with the baseline value of 90.0% ± 2.9% when paper anesthesia records were used. Highest antibiotic compliance was achieved when using real-time alerts. With real-time alerts, monthly compliance was >99% for every month between June 2009 and January 2010.
  
  
  CONCLUSIONS
  Installation of AIMS itself did not improve antibiotic compliance over that achieved with paper anesthesia records. However, real-time guidance and reminders through electronic messages generated by a computerized decision support system (Smart Anesthesia Messenger, or SAM) significantly improved compliance. With such a system a consistent compliance of >99% was achieved.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98195, USA. nairbg@u.washington.edu
authors.forename: Bala G
authors.initials: BG
authors.lastname: Nair
authors.forename: Shu-Fang
authors.initials: SF
authors.lastname: Newman
authors.forename: Gene N
authors.initials: GN
authors.lastname: Peterson
authors.forename: Wei-Ying
authors.initials: WY
authors.lastname: Wu
authors.forename: Howard A
authors.initials: HA
authors.lastname: Schwid
mesh_terms: D000776:Anesthesiology / Q000295:instrumentation*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D020000:Decision Support Systems, Clinical; D004282:Documentation; D004334:Drug Administration Schedule; D034742:Electronic Mail; D030141:Feedback, Psychological; D019983:Guideline Adherence; D006801:Humans; D016347:Medical Records Systems, Computerized; D009862:Online Systems; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D017010:Reminder Systems; D013514:Surgical Procedures, Operative; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013997:Time Factors; D014861:Washington
chemical_list: D000900:Anti-Bacterial Agents