title: Impact of advanced monitoring variables on intraoperative clinical decision-making: an international survey.
abstract: To assess the relationship between the addition of advanced monitoring variables and changes in clinical decision-making. A 15-questions survey was anonymously emailed to international experts and physician members of five anesthesia societies which focused on assessing treatment decisions of clinicians during three realistic clinical scenarios measured at two distinct time points. The first is when typical case information and basic monitoring (T1) were provided, and then once again after the addition of advanced monitoring variables (T2). We hypothesized that the addition of advanced variables would increase the incidence of an optimal therapeutic decision (a priori defined as the answer with the highest percentage of expert agreement) and decrease the variability among the physician's suggested treatments. The survey was completed by 18 experts and 839 physicians. Overall, adding advanced monitoring did not significantly increase physician response accuracy, with the least substantial changes noted on questions related to volume expansion or vasopressor administration. Moreover, advanced monitoring data did not significantly decrease the high level of initial practice variability in physician suggested treatments (P = 0.13), in contrast to the low variability observed within the expert group (P = 0.039). Additionally, 5-10 years of practice (P < 0.0001) and a cardiovascular subspecialty (P = 0.048) were both physician characteristics associated with a higher rate of optimal therapeutic decisions. The addition of advanced variables was of limited benefit for most physicians, further indicating the need for more in depth education on the clinical value and technical understanding of such variables.
authors.affiliation: Department of Anesthesiology and Perioperative Care, University of California, Irvine, 101 the City Drive South, Orange, CA, 92868, USA. joosten-alexandre@hotmail.com.|Department of Anesthesiology, CUB Erasme, Université Libre de Bruxelles, 808 Route de Lennick, 1070, Brussels, Belgium. joosten-alexandre@hotmail.com.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Joosten
authors.affiliation: Department of Anesthesiology and Perioperative Care, University of California, Irvine, 101 the City Drive South, Orange, CA, 92868, USA.|Department of Anesthesiology and Intensive Care, Clinique de la Sauvegarde, 480 Av Ben Gourion, 69009, Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Desebbe
authors.affiliation: Department of Anesthesiology and Perioperative Care, University of California, Irvine, 101 the City Drive South, Orange, CA, 92868, USA.|Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka City, Osaka, 545-8586, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Suehiro
authors.affiliation: Department of Anesthesiology and Perioperative Care, University of California, Irvine, 101 the City Drive South, Orange, CA, 92868, USA.
authors.forename: Mfonobong
authors.initials: M
authors.lastname: Essiet
authors.affiliation: Department of Anesthesiology and Perioperative Care, University of California, Irvine, 101 the City Drive South, Orange, CA, 92868, USA.
authors.forename: Brenton
authors.initials: B
authors.lastname: Alexander
authors.affiliation: Department of Anesthesiology and Perioperative Care, University of California, Irvine, 101 the City Drive South, Orange, CA, 92868, USA.
authors.forename: Cameron
authors.initials: C
authors.lastname: Ricks
authors.affiliation: Department of Anesthesiology and Perioperative Care, University of California, Irvine, 101 the City Drive South, Orange, CA, 92868, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rinehart
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
authors.forename: David
authors.initials: D
authors.lastname: Faraoni
authors.affiliation: Department of Anesthesia and Intensive Care, St George's Hospital and Medical School, London, SW17 0QT, UK.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cecconi
authors.affiliation: Department of Anesthesiology, CHUB Brugmann-QFCHU, Université Libre de Bruxelles, 4 Place Van Gehuchten, 1020, Brussels, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Van der Linden
authors.affiliation: Department of Anesthesiology and Perioperative Care, University of California, Irvine, 101 the City Drive South, Orange, CA, 92868, USA.|Department of Anesthesiology and Perioperative Care, University of California Los Angeles (UCLA), Los Angeles, CA, USA.
authors.forename: Maxime
authors.initials: M
authors.lastname: Cannesson
mesh_terms: D000758:Anesthesia / Q000379:methods; D000776:Anesthesiology / Q000379:methods*; D000066491:Clinical Decision-Making / Q000379:methods*; D003710:Demography; D006801:Humans; D007391:International Cooperation; D015233:Models, Statistical; D016343:Monitoring, Intraoperative / Q000379:methods*; D008991:Monitoring, Physiologic / Q000379:methods*; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012372:ROC Curve; D015203:Reproducibility of Results; D012151:Resuscitation; D018401:Sample Size; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Education; Monitoring; Resuscitation