Development and Feasibility of a Real-Time Clinical Decision Support System for Traumatic Brain Injury Anesthesia Care

• Published in: Applied clinical informatics Vol. 26; no. 1; pp. 80 - 96
• Main Authors: Kiatchai, Taniga, Colletti, Ashley A., Lyons, Vivian H., Grant, Rosemary M., Vavilala, Monica S., Nair, Bala G.
• Format: Journal Article
• Language: English
• Published: Germany Schattauer GmbH 01-01-2017; Schattauer
• Subjects: Anesthesia; Brain Injuries, Traumatic; Decision Support Systems, Clinical; Feasibility Studies; Feedback; Humans; Research Article; Time Factors; clinical decision support; Surgical and anesthesia information systems; alerting
• DOI: 10.4338/ACI-2016-10-RA-0164
• EISSN: 1869-0327

Summary
Background:
Real-time clinical decision support (CDS) integrated with anesthesia information management systems (AIMS) can generate point of care reminders to improve quality of care.
Objective:
To develop, implement and evaluate a real-time clinical decision support system for anesthetic management of pediatric traumatic brain injury (TBI) patients undergoing urgent neurosurgery.
Methods:
We iteratively developed a CDS system for pediatric TBI patients undergoing urgent neurosurgery. The system automatically detects eligible cases and evidence-based key performance indicators (KPIs). Unwanted clinical events trigger and display real-time messages on the AIMS computer screen. Main outcomes were feasibility of detecting eligible cases and KPIs, and user acceptance.
Results:
The CDS system was triggered in 22 out of 28 (79%) patients. The sensitivity of detecting continuously sampled KPIs reached 93.8%. For intermittently sampled KPIs, sensitivity and specificity reached 90.9% and 100%, respectively. 88% of providers reported that CDS helped with TBI anesthesia care.
Conclusions:
CDS implementation is feasible and acceptable with a high rate of case capture and appropriate generation of alert and guidance messages for TBI anesthesia care.