title: Automated reminders decrease postoperative nausea and vomiting incidence in a general surgical population.
abstract: 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 non-cardiac 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 (P=0.01).
  
  
  CONCLUSIONS
  Automated reminders can improve patient outcome by improving guideline adherence.
authors.affiliation: Academic Medical Center, Department of Anesthesiology, PO Box 22660, 1100 DD Amsterdam,  The Netherlands.
authors.forename: F O
authors.initials: FO
authors.lastname: Kooij
authors.forename: N
authors.initials: N
authors.lastname: Vos
authors.forename: P
authors.initials: P
authors.lastname: Siebenga
authors.forename: T
authors.initials: T
authors.lastname: Klok
authors.forename: M W
authors.initials: MW
authors.lastname: Hollmann
authors.forename: J E
authors.initials: JE
authors.lastname: Kal
mesh_terms: D000328:Adult; D000368:Aged; D020000:Decision Support Systems, Clinical; D005260:Female; D013502:General Surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D017010:Reminder Systems