Department of Anesthesia, Duke University Hospital, Durham, NC.
Duke University School of Nursing, Durham, NC.
J Perianesth Nurs. 2021 Aug;36(4):345-350.e1. doi: 10.1016/j.jopan.2020.09.016. Epub 2021 Mar 10.
Approximately 2% of surgical patients have an existing cardiac implantable electronic device (CIED). Perioperative device reprogramming requires postoperative care to ensure that device settings are restored. Electronic health record (EHR) alerts have been shown to improve communication between providers and decrease time to necessary interventions in other areas of medicine. The aim of this quality improvement project was to create an EHR alert for postoperative CIED patients who require device reprogramming to help clinicians track, remember, and document the timely and safe restoration of device settings.
This project used a pre-post observational design.
This project was conducted at a major academic medical center using a pre-post observational design. To prevent anesthesia providers from closing an encounter in the EHR before postoperative restoration of device settings, an alert was developed and embedded within the intraoperative EHR to track preoperative device reprogramming, and alert anesthesia providers to perform and document postoperative restoration of safe settings.
The postimplementation group (n = 272) had fewer unknown or undocumented preoperative CIED interventions (12.9% vs 30.9%), a 7.3% shorter device suspension time (median = 165 minutes vs 178 minutes), 6.8% improvement in documentation of postoperative re-enabling of device therapies (78.8% vs 72.0%), and a 72.48% decrease in length of stay (median = 625 hours vs 172 hours) when compared with the preimplementation group (n = 132).
Electronic prompts effectively captured patients who received preoperative CIED reprogramming and provided a process for reprogramming devices to safe settings, both significant steps in preventing negative patient outcomes associated with undocumented CIED interventions. Perioperative CIED documentation improved, and length of stay decreased after project implementation.
大约有 2%的手术患者拥有现有的心脏植入式电子设备（CIED）。围手术期设备重新编程需要术后护理，以确保设备设置得到恢复。电子健康记录（EHR）警报已被证明可以改善提供者之间的沟通，并减少其他医学领域必要干预的时间。本质量改进项目的目的是为需要设备重新编程的术后 CIED 患者创建一个 EHR 警报，以帮助临床医生跟踪、记住并记录设备设置的及时和安全恢复。
本项目采用了前后观测设计。
本项目在一家主要的学术医疗中心进行，采用前后观测设计。为了防止麻醉师在设备设置恢复后关闭 EHR 中的就诊记录，开发了一个警报，并将其嵌入术中 EHR 中，以跟踪术前设备重新编程，并提醒麻醉师执行并记录安全设置的术后恢复。
实施后组（n=272）的术前 CIED 干预措施未知或未记录的情况更少（12.9%比 30.9%），设备暂停时间缩短了 7.3%（中位数=165 分钟比 178 分钟），术后重新启用设备治疗的记录改善了 6.8%（78.8%比 72.0%），住院时间缩短了 72.48%（中位数=625 小时比 172 小时），与实施前组（n=132）相比。
电子提示有效地捕获了接受术前 CIED 重新编程的患者，并提供了将设备重新编程到安全设置的过程，这是防止与未记录的 CIED 干预相关的负面患者结局的重要步骤。术后 CIED 文档得到了改善，并且项目实施后住院时间缩短。
