Information Management

Comparison of automated and manual anesthesia record keeping
Video observation study analyzing anesthesia related tasks

Ilkka Kalli, MD1, Ristomatti Partanen, MSc2, Kari Hermunen, MD3
HUCH Peijas Hospital 3 and Maternity Hospital1 , Helsinki University Hospital, Department of Anesthesiology and Intensive Care Medicine, Helsinki, Finland and Datex-Ohmeda Division, Instrumentarium Corporation1,2
[Poster presentation: European Academy of Anesthesiology annual meeting in Helsinki]

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Aims of the study

Automated anesthetic records allow increased accuracy of data collection. That may be a benefit e.g. when medico-legal reasons are considered. Presumably, the automated anesthesia record keeping (AARK) compared to the traditional pen and paper approach may change the way anesthesia staff works (1-3). When Peijas Hospital (City of Vantaa, Finland) decided to purchase a new anesthesia documentation system, we were interested in analyzing its influence on routine anesthesia practice. We also wanted to compare the applicability of automated and manual anesthesia records.

Methods

After institutional approval and with informed consent, five nurse anesthetists were selected for the study. The idea was to include clinicians who have had years of experience in O.R. and those who just recently had started their clinical practice. Each study subject performed one case with manual record keeping and one case with AARK.

It provided automated vital-signs collection and pre-configured record keeper menus that were designed according to wishes of the staff.

In order to standardize the case, only elective ASA 1-2 hysterectomies were included in the study. In the manual records group, a standard hospital record form was used. Automated records were created with AS/3 AM (Datex-Ohmeda, Helsinki, Finland) multiparameter monitor including a record keeping software.

An independent observer was present in all cases. Each case was video recorded from the moment patient was asleep until extubation and transport to the recovery area. All video recordings were postoperatively analyzed: each single task was selected, and its duration in seconds was measured. For descriptive analysis of data, mean and median values with ranges were used.

For analysis and data presentation the data were later combined into five major categories representing typical task groups during anesthesia (recording anesthesia, direct patient care, supplementary activities, watching surgery and communication) (Table: task categories).

Results

All ten hysterectomies were uneventful, there were no abnormal occurrences which might have influenced the way record keeping was performed (Table: durations).

Total duration of video recordings was 1300 minutes. When recordings of the five manual and five automated cases were analyzed, a total of 3915 entries were stored in the database.

Interestingly, the workload of recording anesthesia seems to be less with AARK than with manual records (12.9% vs. 21.9% of the duration of general anesthesia) (Figure: time usage).

On the contrary, more time can be allocated to direct patient care in the AARK group (34.9%) than in the manual records group (29.0%).

Two of the major categories "communication" and "watching surgery" were selected as indicators of anesthesia teamwork. The relative duration of both indicators seems to be independent of the way record keeping is used.

Table: Time usage

The five main anesthesia task categories are shown as mean percentages of total duration of general anesthesia. Five anesthesia nurses performed one case each, keeping a manual anesthesia record, and one case using the automated record keeping system.

During a hysterectomy case, work needed for automated record keeping is less, compared to filling of the traditional manual record. Anesthesia is teamwork. Thus, basic activities like communication with others and watching of the surgical field are independent of the way record keeping is done. There seems to be more time for direct patient care in the automated records groups.

Table: Duration

Durations of the ten study cases (hysterectomies). Video recording was started when the patient was in sleep. Anesthesia time is the duration of stay in the O.R. when patient is anaesthetized but not operated. Surgery time is the duration of surgical procedure. Occasionally, duration of stay in the O.R. was prolonged because of delays which were neither related to anesthesia activity nor study recordings. There were three ASA 1 and two ASA 2 patients in the manual records group and two ASA 1 and three ASA 2 patients in the automated records group.

Table: Task categories

Anesthesia task main categories and how they were formed from the original subcategories.

Figure: time usage

The five main anesthesia task categories are shown as mean percentages of total duration of general anesthesia. Five anesthesia nurses performed one case each, keeping a manual anesthesia record, and one case using the automated record keeping system.During a hysterectomy case, work needed for automated record keeping is less, compared to filling of the traditional manual record.

Anesthesia is teamwork. Thus, basic activities like communication with others and watching of the surgical field are independent of the way record keeping is done. There seems to be more time for direct patient care in the automated records groups.

Comments on findings

The automated record keeper generates menus on a monitor display and allows moving the cursor on the menus by rotation of a knob. That seems to be a working idea, as menus can be designed according to users needs. Typically, the documentation needs of a high risk anesthesia case (e.g. open heart surgery) are quite different from the needs in an adenotomy of a pediatric patient or in an orthopedic procedure. Even drug doses or drug infusion rates are documented using a wheel to move menu cursor. This concept of reducing the need of direct typing may be good to decrease time used in documentation.

The cursor moves only in vertical direction making selections more easily than with some microcomputer pointing device like mouse. Another benefit is that there is no need for an extra table base for a mouse.

The need to type direct information from the keyboard was minimal. The less typing from the keyboard the better, since most of the staff are not ten finger typists. Thus, it seems that the idea of having menus on the monitor display and to move the menu cursor by using a rotary knob seems to be a working principle.

References

1. Kalli, I. Automated anesthesia documentation: clinical evaluations in Helsinki University Central Hospital. Baillière’s Clinical Anaesthesiology 1990; 4: 141-152.
2. Edsall D.W., Deshane P., Giles C., Sloan B. Computerized patient anesthesia records: Less time and better quality than manually produced anesthesia records. Journal of Clinical Anesthesia 1993; 5: 275-283.
3. Allard J., Dzwonczyk R., Yablok D. , Block F.E., McDonald J.S. Effect of automatic record keeping on vigilance and record keeping time. British Journal of Anesthesia 1995; 74: 619-626.

Acknowledgement

Datex-Ohmeda (Helsinki, Finland) provided video recording devices and technical assistance which proved invaluable in analyzing the significant amount of data. That support is kindly appreciate

Last updated: 1 January 2002Created
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