title: Does manual anaesthetic record capture remove clinically important data?
abstract: BACKGROUND
  Numerous studies have shown smoothing and inaccuracies in handwritten anaesthetic records, but the clinical relevance of these findings is unclear. We therefore sought to determine whether the behaviour of anaesthetists differed in assessing anaesthetic records re-synthesized from either handwritten or automated records.
  
  
  METHODS
  In a recent New Zealand study (ACTRN12608000068369), both manual and automated records were acquired from the same anaesthetics. Manual records were digitized using digital callipers. Selected data (systolic, diastolic, and mean arterial pressure; heart rate; Sp(O(2)); E'(CO(2))) were replayed in a computerized anaesthetic record-keeping system with which the participants were familiar, to present manual and corresponding automated anaesthetic records. Ten anaesthetists, randomly selected from participants in this study, assessed 24 replayed records (a manual and an automated record from each of 10 anaesthetics, with two of each displayed twice). They indicated where and how they would have intervened if administering these anaesthetics. We compared the number of interventions for each pair of anaesthetics and subjective measures of anaesthetic quality.
  
  
  RESULTS
  In our selected sample of unstable anaesthetics, the mean (SD) number of interventions per anaesthetic was 4.0 (2.9) vs 5.2 (3.4) for manual and automated records, respectively (P=0.013). Subjective measures did not differ significantly between record types. Assessors identified 32 artifacts in six manual records (0.32/record assessment) and 105 artifacts in eight automated records (1.05/record assessment), P=0.14. Replicability was moderate (COV 39.8%).
  
  
  CONCLUSIONS
  In comparison with computerized record-keeping, manual record-keeping resulted in loss of clinically relevant information.
authors.affiliation: Auckland City Hospital, P/Bag 92024, Auckland 1023, New Zealand. johanvs@adhb.govt.nz
authors.forename: J M
authors.initials: JM
authors.lastname: van Schalkwyk
authors.forename: D
authors.initials: D
authors.lastname: Lowes
authors.forename: C
authors.initials: C
authors.lastname: Frampton
authors.forename: A F
authors.initials: AF
authors.lastname: Merry
mesh_terms: D000004:Abbreviations as Topic; D000758:Anesthesia / Q000706:statistics & numerical data*; D000777:Anesthetics; D016477:Artifacts; D003627:Data Interpretation, Statistical; D004282:Documentation / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D023381:Endpoint Determination; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D020407:Internet; D008499:Medical Records; D016347:Medical Records Systems, Computerized; D016343:Monitoring, Intraoperative / Q000706:statistics & numerical data; D009520:New Zealand; D010100:Oxygen / Q000097:blood; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D012984:Software
chemical_list: D000777:Anesthetics; D010100:Oxygen