title: Near real-time notification of gaps in cuff blood pressure recordings for improved patient monitoring.
abstract: Blood pressure monitoring during anesthesia is an American Society of Anesthesiology standard. However, the anesthesia provider sometimes fails to engage the patient monitor to make periodic (generally every 3-5 min) measurements of Non-Invasive Blood Pressure (NIBP), which can lead to extended periods (>5 min) when blood pressure is not monitored. We describe a system to automatically detect such gaps in NIBP measurement and notify clinicians in real-time to initiate measurement. We applied a decision support system called the Smart Anesthesia Messenger (SAM) to notify the anesthesia provider if NIBP measurements have not been made in the last 7 min. Notification messages were generated only if direct arterial blood pressure was not being monitored. NIBP gaps were analyzed for 9 months before and after SAM notification was initiated (12,000 cases for each period). SAM notification was able to reduce the occurrence of extended NIBP gaps >15 min from 15.7 ± 4.5 to 6.7 ± 2.0 instances per 1,000 cases (p < 0.001). In addition, for extended gaps (>15 min) the mean gap duration declined from 23.1 ± 2.0 to 18.6 ± 1.1 min after SAM notification was initiated (p < 0.001). However, for 7-15 min gaps, SAM notification was not effective in reducing the occurrence. The maximum gap encountered before SAM was 64 min, while it was 27 min with SAM notification. Real-time notification using SAM is an effective way to reduce both the number of instances and the duration of inadvertent, extended (>15 min) gaps in blood pressure measurements in the operating room. However, the frequency of gaps <15 min could not be reduced using the current configuration of SAM.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, BB-1469 Health Sciences Bldg, 1959 NE Pacific Street, Mail Box: 356540, Seattle, WA 98195, USA. nairbg@uw.edu
authors.forename: Bala G
authors.initials: BG
authors.lastname: Nair
authors.forename: Mayumi
authors.initials: M
authors.lastname: Horibe
authors.forename: Shu-Fang
authors.initials: SF
authors.lastname: Newman
authors.forename: Wei-Ying
authors.initials: WY
authors.lastname: Wu
authors.forename: Howard A
authors.initials: HA
authors.lastname: Schwid
mesh_terms: D000758:Anesthesia / Q000592:standards; D001795:Blood Pressure Determination / Q000592:standards / Q000706:statistics & numerical data*; D003199:Computer Systems; D020000:Decision Support Systems, Clinical; D006801:Humans; D016343:Monitoring, Intraoperative / Q000592:standards / Q000706:statistics & numerical data*