Klumpner Thomas T, Kountanis Joanna A, Langen Elizabeth S, Smith Roger D, Tremper Kevin K
Department of Anesthesiology, University of Michigan, 1H247 University Hospital, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5048, USA.
Department of Obstetrics and Gynecology, Von Voigtlander Women's Hospital, University of Michigan, Ann Arbor, MI, USA.
BMC Anesthesiol. 2018 Jun 26;18(1):78. doi: 10.1186/s12871-018-0540-6.
Maternal early warning systems reduce maternal morbidity. We developed an electronic maternal surveillance system capable of visually summarizing the labor and delivery census and identifying changes in clinical status. Automatic page alerts to clinical providers, using an algorithm developed at our institution, were incorporated in an effort to improve early detection of maternal morbidity. We report the frequency of pages generated by the system. To our knowledge, this is the first time such a system has been used in peripartum care.
Alert criteria were developed after review of maternal early warning systems, including the Maternal Early Warning Criteria (MEWC). Careful consideration was given to the frequency of pages generated by the surveillance system. MEWC notification criteria were liberalized and a paging algorithm was created that triggered paging alerts to first responders (nurses) and then managing services due to the assumption that paging all clinicians for each vital sign triggering MEWC would generate an inordinate number of pages. For preliminary analysis, to determine the effect of our automated paging algorithm on alerting frequency, the paging frequency of this system was compared to the frequency of vital signs meeting the Maternal Early Warning Criteria (MEWC). This retrospective analysis was limited to a sample of 34 patient rooms uniquely capable of storing every vital sign reported by the bedside monitor.
Over a 91-day period, from April 1 to July 1, 2017, surveillance was conducted from 64 monitored beds, and the obstetrics service received one automated page every 2.3 h. The most common triggers for alerts were for hypertension and tachycardia. For the subset of 34 patient rooms uniquely capable of real-time recording, one vital sign met the MEWC every 9.6 to 10.3 min. Anecdotally, the system was well-received.
This novel electronic maternal surveillance system is designed to reduce cognitive bias and improve timely clinical recognition of maternal deterioration. The automated paging algorithm developed for this software dramatically reduces paging frequency compared to paging for isolated vital sign abnormalities alone. Long-term, prospective studies will be required to determine its impact on patient outcomes.
孕产妇早期预警系统可降低孕产妇发病率。我们开发了一种电子孕产妇监测系统，该系统能够直观地汇总分娩普查情况并识别临床状态的变化。通过使用我们机构开发的算法，向临床医护人员发送自动页面警报，以努力改善对孕产妇发病率的早期检测。我们报告了该系统生成页面警报的频率。据我们所知，这是此类系统首次用于围产期护理。
在回顾包括孕产妇早期预警标准（MEWC）在内的孕产妇早期预警系统后制定了警报标准。仔细考虑了监测系统生成页面警报的频率。放宽了MEWC通知标准，并创建了一种分页算法，该算法首先向急救人员（护士）触发分页警报，然后向管理服务部门触发警报，这是因为假设针对每个触发MEWC的生命体征向所有临床医生发送分页警报会产生过多的页面警报。为了进行初步分析，以确定我们的自动分页算法对警报频率的影响，将该系统的分页频率与符合孕产妇早期预警标准（MEWC）的生命体征频率进行了比较。这项回顾性分析仅限于34个能够存储床边监护仪报告的每个生命体征的病房样本。
在2017年4月1日至7月1日的91天期间，对64张监测床位进行了监测，产科服务部门每2.3小时收到一次自动页面警报。最常见的警报触发因素是高血压和心动过速。对于3个4能够实时记录的病房子集，每9.6至10.3分钟就有一个生命体征符合MEWC。据传闻，该系统受到好评。
这种新型的电子孕产妇监测系统旨在减少认知偏差并改善对孕产妇病情恶化的及时临床识别。与仅针对孤立的生命体征异常进行分页相比，为此软件开发的自动分页算法大大降低了分页频率。需要进行长期的前瞻性研究来确定其对患者结局的影响。
