title: Documentation and Treatment of Intraoperative Hypotension: Electronic Anesthesia Records versus Paper Anesthesia Records.
abstract: In this study, we examined anesthetic records before and after the implementation of an electronic anesthetic record documentation (AIMS) in a single surgical population. The purpose of this study was to identify any inconsistencies in anesthetic care based on handwritten documentation (paper) or AIMS. We hypothesized that the type of anesthetic record (paper or AIMS) would lead to differences in the documentation and management of hypotension. Consecutive patients who underwent esophageal surgery between 2009 and 2014 by a single surgeon were eligible for the study. Patients were grouped in to 'paper' or 'AIMS' based on the type of anesthetic record identified in the chart. Pertinent patient identifiers were removed and data collated after collection. Predetermined preoperative and intraoperative data variables were reviewed. Consecutive esophageal surgery patients (N = 189) between 2009 and 2014 were evaluated. 92 patients had an anesthetic record documented on paper and 97 using AIMS. The median number of unique blood pressure recordings was lower in the AIMS group (median (Q1,Q3) AIMS 30.0 (24.0, 39.0) vs. Paper 35.0 (28.5, 43.5), p < 0.01). However, the median number of hypotensive events (HTEs) was higher in the AIMS group (median (Q1,Q3) 8.0 (4.0, 18.0) vs. 4.0 (1.0, 10.5), p < 0.001), and the percentage of HTEs per blood pressure recording was higher in the AIMS group (30.4 ((Q1, Q3) (9.5, 60.9)% vs. 12.5 (2.4, 27.5)%), p < 0.01). Multivariable regression analysis identified independent predictors of HTEs. The incidence of HTEs was found to increase with AIMS (IRR = 1.88, p < 0.01). Preoperative systolic blood pressure, increased blood loss, and phenylephrine. A phenylephrine infusion was negatively associated with hypotensive events (IRR = 0.99, p = 0.03). We noted an increased incidence of HTEs associated with the institution of an AIMS. Despite this increase, no change in medical therapy for hypotension was seen. AIMS did not appear to have an effect on the management of intraoperative hypotension in this patient population.
authors.affiliation: Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, 2650 Ridge Ave, Evanston, IL, 60201, USA. torinshear@gmail.com.
authors.forename: Torin D
authors.initials: TD
authors.lastname: Shear
authors.affiliation: Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Deshur
authors.affiliation: Center for Biomedical Research Informatics, NorthShore University HealthSystem Research Institute, Evanston, IL, USA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Lapin
authors.affiliation: Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Greenberg
authors.affiliation: Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Murphy
authors.affiliation: Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Szokol
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, IL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Ujiki
authors.affiliation: Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Newmark
authors.affiliation: Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Benson
authors.affiliation: Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Cody
authors.initials: C
authors.lastname: Koress
authors.affiliation: Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Connor
authors.initials: C
authors.lastname: Dwyer
authors.affiliation: Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, 2650 Ridge Ave, Evanston, IL, 60201, USA.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Vender
mesh_terms: D000758:Anesthesia; D001794:Blood Pressure; D004282:Documentation; D006801:Humans; D007022:Hypotension; D007430:Intraoperative Care; D016343:Monitoring, Intraoperative
keywords: Aims; Anesthesia information management system; Electronic anesthesia record; Hypotension; Paper record