Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Appl Clin Inform. 2023 Mar;14(2):238-244. doi: 10.1055/a-2011-8259. Epub 2023 Jan 12.
Poorly functioning labor epidural catheters lead to pain and dissatisfaction. Regular catheter assessment ensures timely identification of malfunction and may improve safety by facilitating rapid and successful conversion to general anesthesia for emergency cesarean. Informatics-based systems encourage standardization of care to identify epidural malfunctions earlier.
This article demonstrates that visual epidural rounding reminder display on an electronic patient board would alert clinicians to elapsed time and decrease mean time between assessments.
As a quality initiative, we implemented an epidural rounding reminder on our obstetric patient board. The reminder indicated the number of elapsed minutes since placement or last patient assessment. We retrospectively reviewed labor epidural charts 3 months prior to and 5 months following reminder implementation, with a 4-week washout period. The primary outcome was mean time between documented epidural assessments, with secondary outcomes including maximum time between assessments, total number of assessments during labor, catheter replacement rates, and patient satisfaction. Unadjusted comparisons between pre- and postimplementation groups were conducted using Wilcoxon's rank-sum and Pearson's chi-square tests, as appropriate. A test for equal variances was conducted for time between assessment outcomes.
Following implementation, mean time between assessments decreased from a median of 173 (interquartile range [IQR]: 53, 314) to 100 (IQR: 74, 125) minutes ( <0.001), and maximum time between assessments decreased from median 330 (IQR: 60, 542) to 162 (IQR: 125, 212) minutes ( < 0.001). Total number of evaluations during labor increased from 3 (IQR: 2, 4) to 5 (IQR: 3, 7; < 0.001). Decreased variance in mean and maximum time between assessments was noted following reminder implementation ( < 0.001). Epidural replacement rates decreased from 14 to 5% postimplementation ( < 0.001). Patient satisfaction was unchanged.
Implementation of an informatics-based solution can promote standardization of care. A simple epidural rounding reminder prompted clinicians to perform more frequent labor epidural assessments. In the future, these process improvements must be linked to improvements in patient experiences and outcomes.
功能不良的分娩硬膜外导管会导致疼痛和不满。定期对导管进行评估可确保及时发现故障，并通过促进紧急剖宫产时迅速成功地转为全身麻醉来提高安全性。基于信息学的系统鼓励标准化护理，以更早地识别硬膜外故障。
本文证明，在电子患者板上显示视觉硬膜外巡回提醒显示器将提醒临床医生经过的时间，并减少评估之间的平均时间。
作为一项质量倡议，我们在产科患者板上实施了硬膜外巡回提醒。该提醒指示了自放置或上次患者评估以来经过的分钟数。我们回顾性地审查了提醒实施前 3 个月和实施后 5 个月的分娩硬膜外图表，并有 4 周的洗脱期。主要结局是记录的硬膜外评估之间的平均时间，次要结局包括评估之间的最大时间、分娩期间的总评估次数、导管更换率和患者满意度。使用 Wilcoxon 秩和检验和 Pearson 卡方检验（视情况而定）对实施前后组进行了未经调整的比较。对评估结果之间的方差进行了相等方差检验。
实施后，评估之间的平均时间从中位数 173（四分位距 [IQR]：53，314）减少到 100（IQR：74，125）分钟（<0.001），最大时间从中位数 330（IQR：60，542）减少到 162（IQR：125，212）分钟（<0.001）。分娩期间的评估总数从 3（IQR：2，4）增加到 5（IQR：3，7；<0.001）。实施提醒后，平均和最大时间之间的方差减少（<0.001）。实施后，硬膜外更换率从 14%降至 5%（<0.001）。患者满意度保持不变。
基于信息学的解决方案的实施可以促进护理标准化。简单的硬膜外巡回提醒提示临床医生更频繁地进行分娩硬膜外评估。在未来，这些流程改进必须与患者体验和结果的改善联系起来。
