Sreepada Rama Syamala, Chang Ai Ching, West Nicholas C, Sujan Jonath, Lai Brendan, Poznikoff Andrew K, Munk Rebecca, Froese Norbert R, Chen James C, Görges Matthias
Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada.
Research Institute, BC Children's Hospital, Vancouver, BC, Canada.
JMIR Perioper Med. 2023 Sep 19;6:e47398. doi: 10.2196/47398.
Anesthesiologists require an understanding of their patients' outcomes to evaluate their performance and improve their practice. Traditionally, anesthesiologists had limited information about their surgical outpatients' outcomes due to minimal contact post discharge. Leveraging digital health innovations for analyzing personal and population outcomes may improve perioperative care. BC Children's Hospital's postoperative follow-up registry for outpatient surgeries collects short-term outcomes such as pain, nausea, and vomiting. Yet, these data were previously not available to anesthesiologists.
This quality improvement study aimed to visualize postoperative outcome data to allow anesthesiologists to reflect on their care and compare their performance with their peers.
The postoperative follow-up registry contains nurse-reported postoperative outcomes, including opioid and antiemetic administration in the postanesthetic care unit (PACU), and family-reported outcomes, including pain, nausea, and vomiting, within 24 hours post discharge. Dashboards were iteratively co-designed with 5 anesthesiologists, and a department-wide usability survey gathered anesthesiologists' feedback on the dashboards, allowing further design improvements. A final dashboard version has been deployed, with data updated weekly.
The dashboard contains three sections: (1) 24-hour outcomes, (2) PACU outcomes, and (3) a practice profile containing individual anesthesiologist's case mix, grouped by age groups, sex, and surgical service. At the time of evaluation, the dashboard included 24-hour data from 7877 cases collected from September 2020 to February 2023 and PACU data from 8716 cases collected from April 2021 to February 2023. The co-design process and usability evaluation indicated that anesthesiologists preferred simpler designs for data summaries but also required the ability to explore details of specific outcomes and cases if needed. Anesthesiologists considered security and confidentiality to be key features of the design and most deemed the dashboard information useful and potentially beneficial for their practice.
We designed and deployed a dynamic, personalized dashboard for anesthesiologists to review their outpatients' short-term postoperative outcomes. This dashboard facilitates personal reflection on individual practice in the context of peer and departmental performance and, hence, the opportunity to evaluate iterative practice changes. Further work is required to establish their effect on improving individual and department performance and patient outcomes.
麻醉医生需要了解患者的治疗结果，以评估自身表现并改进工作。传统上，由于出院后接触极少，麻醉医生对其外科门诊患者的治疗结果了解有限。利用数字健康创新技术分析个人和群体治疗结果可能会改善围手术期护理。不列颠哥伦比亚儿童医院的门诊手术术后随访登记系统收集疼痛、恶心和呕吐等短期治疗结果。然而，麻醉医生此前无法获取这些数据。
这项质量改进研究旨在将术后治疗结果数据可视化，使麻醉医生能够反思自己的护理工作，并将自己的表现与同行进行比较。
术后随访登记系统包含护士报告的术后治疗结果，包括麻醉后护理单元（PACU）的阿片类药物和止吐药使用情况，以及家属报告的出院后24小时内的治疗结果，包括疼痛、恶心和呕吐。与5名麻醉医生反复共同设计仪表板，全科室可用性调查收集了麻醉医生对仪表板的反馈，从而进一步改进设计。最终版本的仪表板已投入使用，数据每周更新。
仪表板包含三个部分：（1）24小时治疗结果，（2）PACU治疗结果，（3）包含按年龄组、性别和手术科室分组的个体麻醉医生病例组合的实践概况。在评估时，仪表板包括2020年9月至2023年2月收集的7877例病例的24小时数据，以及2021年4月至2023年2月收集的8716例病例的PACU数据。共同设计过程和可用性评估表明，麻醉医生更喜欢更简单的数据汇总设计，但也需要能够在需要时探索特定治疗结果和病例的详细信息。麻醉医生认为安全性和保密性是设计的关键特征，大多数人认为仪表板信息对他们的工作有用且可能有益。
我们为麻醉医生设计并部署了一个动态的、个性化的仪表板，用于查看其门诊患者的术后短期治疗结果。该仪表板有助于在同行和科室表现的背景下对个人实践进行反思，从而有机会评估迭代实践变化。需要进一步开展工作，以确定它们对改善个人和科室表现以及患者治疗结果的影响。
