Marquardt K

Clinical and practical requirements of online software for anesthesia documentation : an experience report

The aim of this paper is the presentation of a new version of the anesthesia documentation software, NarkoData, that has been used in routine clinical work in our department as part of an anesthesia information management system (AIMS) since 1995. The performance of this software is presented along with requirements for future development of such a system. The originally used version, NarkoData 3.0, is an online anesthesia documentation software established by the software company ProLogic GmbH. It was primarily developed as a disk-based system for the MacOS operating system (Apple Computer Inc.). Based on our routine experience with the system, a catalogue of requirements was developed that concentrated on improvement in the sequence of work, administration and data management. In 1996, the concepts developed in our department, in close co-operation with medical personnel and the software company, led to a considerable enlargement of the program functions and the subsequent release of a new version of NarkoData. Since 1997, more than 20 000 anesthesia procedures have been recorded annually with this new version at 115 decentralized work stations at our university hospital.

Discriminative power on mortality of a modified Sequential Organ Failure Assessment score for complete automatic computation in an operative intensive care unit.

Objective To evaluate the discriminative power on mortality of a modified Sequential Organ Failure Assessment (SOFA) score and derived measures (maximum SOFA, total maximum SOFA, and delta SOFA) for complete automatic computation in an operative intensive care unit (ICU). Design Retrospective study. Setting Operative ICU of the Department of Anesthesiology and Intensive Care Medicine. Patients Patients admitted to the ICU from April 1, 1999, to March 31, 2000 (n = 524). Data from patients under the age of 18 yrs and patients who stayed <24 hrs were excluded. In the case of patient readmittance, only data from the patient’s last stay was included in the study. Interventions None. Measurements and Main Results The main outcome measure was survival status at ICU discharge. Based on Structured Query Language (SQL) scripts, a modified SOFA score for all patients who stayed in the ICU in 1 yr was calculated for each day in the ICU. Only routine data were used, which were supplied by the patient data management system. Score evaluation was modified in registering unavailable data as being not pathologic and in using a surrogate of the Glasgow Coma Scale. During the first 24 hrs, 459 survivors had an average SOFA score of 4.5 ± 2.1, whereas the 65 deceased patients averaged 7.6 ± 2.9 points. The area under the receiver operating characteristic (ROC) curve was 0.799 and significantly >0.5 (p < .01). A confidence interval (CI) of 95% covers the area (0.739–0.858). The maximum SOFA presented an area under the ROC of 0.922 (CI: 0.879–0.966), the total maximum SOFA of 0.921 (CI: 0.882–0.960), and the delta SOFA of 0.828 (CI: 0.763–0.893). Conclusion Despite a number of differences between completely automated data sampling of SOFA score values and manual evaluation, the technique used in this study seems to be suitable for prognosis of the mortality rate during a patient’s stay at an operative ICU.

Evaluation of the suitability of a patient data management system for ICUs on a general ward

The development of the ICUData patient data management system (PDMS) for intensive care units (ICU), by IMESO GmbH, Hüttenberg, Germany, was based on the assumption that processes and therapies at ICU are the most complex with the highest data density compared with those in other wards. Based on experience with the system and on a survey conducted among users at our pain clinic, we evaluated whether the concept of the present software architecture, which sufficiently reproduces processes and data at an ICU, is suitable as a PDMS for general wards. The highly modular and client-centric approach of the PDMS is founded on a message-based communications architecture (HL7). In the beginning of the year 2000, the system was implemented at the pain management clinic (12 beds) of our hospital. To assess its user friendliness, we conducted a survey of medical staff (n=14). From April 1st 2000 to August 31st 2000, all clinical and administrative data of 658 patients at the pain management clinic were recorded with the PDMS. From the start, all users had access to data and information of other connected data management systems of the hospital (e.g. patient administrative data, patient clinical data). Staff members found the system mostly useful, clearly presented, practical, and easy to learn and use. Users were relatively satisfied with stability and performance of the program but mentioned having only limited knowledge of the programs features. The need for external support during a computer crash was rated negatively. Despite the need for further usage training and improved program performance, the software architecture described seems to be a promising starting point for the construction of a PDMS for general wards.

A data model for managing drug therapy within a patient data management system for intensive care units

The major intent of this article was to describe the design principles of the drug-therapy documentation module of the Patient Data Management System (PDMS) ICUData, in routine use at the intensive care unit (ICU) of the Department of Anesthesiology and Intensive Care Medicine at the University Hospital of Giessen, Germany, since February 1999. The new drug management system has been in routine use since March 2000. Until 8 January 2001, 1140 patients have been documented using this approach. It could be demonstrated that it was possible to transform the formerly unstructured text-based documentation into a detailed and structured model. The mediated benefit resulted in the automatic calculation of fluid balance. Further, detailed statistical analyses of therapeutic behavior in drug administration are now possible.

Einsatz eines Anästhesie-Informations-Management-Systems (AIMS) in einer Operativen Tagesklinik

ZusammenfassungVon Januar 1997 bis Juni 1999 wurde der komplette Aufenthalt aller tageschirurgischen Patienten, von der Aufnahme bis zur Entlassung, mit einem computergestützten Dokumentationssystem erfasst. Einzelne Aspekte und Ergebnisse aus dem Routinebetrieb sollen mit der Fragestellung vorgestellt werden, ob ein Anästhesie-Informations-Management-System (AIMS) geeignet ist, auch im Bereich des “Ambulanten Operierens” eine umfassende und qualitativ hochwertige Dokumentation zu gewährleisten. Methodik. Die Installation des Systems erfolgte durch Einbindung von 8 Bettplatz-Computern und eines weiteren Clients über das Intranet in das bestehende AIMS. An den tagesstationären Bettplätzen wurden Patientendaten prä- und postoperativ bis zur Entlassung oder Verlegung der Patienten mit der Online-Dokumentationssoftware NarkoData® Version 4 (Imeso GmbH, Hüttenberg) dokumentiert und in einer Datenbank gespeichert. Dieses Programm erfasst sämtliche für den Narkoseverlauf und tagesstationären Aufenthalt relevanten Informationen, u. a. Medikamentenapplikationen, Vitaldaten, Überwachungszeiten, Befunde sowie den Kerndatensatz der DGAI, ICD 9 und ICPM. Zur Auswertung wurden die Daten mittels der “Structured Query Language” (SQL) aus der Datenbank in ein Statistikprogramm exportiert. Ergebnisse. Die Datensätze von 3.152 tagesstationären Patienten wurden mit der Online-Dokumentationssoftware erfasst. Die häufigsten tageschirurgischen Operationen führte mit 54,2% der Fälle die operierende Fachabteilung Unfallchirurgie durch, gefolgt von der Allgemeinchirurgie mit 16,0% und der Urologie mit 9,5%. Die häufigsten tageschirurgischen Eingriffe waren diagnostische Arthroskopie (923, 31,2%), Entfernung von Osteosynthesematerial (410, 13,8%) und die Zirkumzision (250, 8,4%). Von anästhesiologischer Seite kamen zumeist die Inhalationsnarkose (38,6%, n=1218) und die intravenöse Anästhesie (IVA; 29,9%, n=938) zum Einsatz. Eine Regionalanästhesie wurde in 22,6% der Fälle (n=713) durchgeführt. Die durchschnittliche postoperative Überwachungszeit betrug 289,2±140,1 min. 169 Patienten (5,4%) wurden ungeplant stationär aufgenommen. Die Entscheidung zu einer stationären Aufnahme wurde bei 50,9% der stationär aufgenommenen Patienten intraoperativ oder in den ersten drei postoperativen Stunden gefällt. Schlussfolgerung. Das beschriebene AIMS ist geeignet, den gesamten Behandlungsprozess eines Patienten in einer operativen Tagesklinik zu dokumentieren. Die Integration in das bestehende System stellte sich als wesentliche Voraussetzung für die Integrität der Dokumentationskette heraus und ermöglicht eine sinnvolle Kommunikation mit anderen klinischen Datenverarbeitungssystemen. Wie auch im Bereich der Anästhesie konnten die Dokumentationsqualität und der Informationsfluss am Narkosearbeitsplatz gesteigert werden. Neben medizinischen und administrativen Daten stehen Informationen für die Analyse klinischer Prozesse zur Verfügung.AbstractFrom January 1997 until June 1999, the complete durations of stay of 3152 outpatients were entered into a computerized documentation system. The scope of the data entry went from patient admission to patient release. The objective was to determine the usefulness of the anaesthesia information management system (AIMS) in producing complete and high-quality documentation in the field of outpatient operations. Some aspects and results from routine work are presented here. Method. The system was installed in eight bedside computers, in addition to a further client connected to the existing AIMS via Ethernet. Patient medical courses were documented both preoperatively and postoperatively in outpatient bedsides until their discharge or admission. The online documentation software NarkoData (Version 4, Imeso GmbH, Hüttenberg, Germany) was used to document and store patient data in a database. This program contains all relevant information concerning the course of anaesthesia and outpatient duration of stay, including application of drugs, vital signs, observation times, and medical findings as well as the data sets of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), ICD, and ICPM. Data was analyzed by exporting from the database into a statistical program using “structured query language.” Results. Data sets of 3152 outpatients were entered into the online documentation software. Most (54.2%) of the ambulatory surgical procedures were performed by the Department of Traumatology. General Surgery followed with 16.0%, and Urology managed 9.5% of the cases. The most frequent ambulatory surgical procedures were: diagnostic arthroscopy (923, 31.2%), removal of osteosynthetic material (410, 13.8%), and circumcision (250, 8.4%). Anesthesia procedures consisted of inhalative (38.6%, n=1218) and intravenous anesthesia (IVA) (29.9%, n=938). In 22.6% (713) of the cases, regional anaesthesia was performed. The average postoperative observation time was 289.2±140.1 minutes. One hundred sixty-nine patients (5.4%) were unexpectedly admitted to overnight care. The decision to admit patients to normal wards took place within the first 3 postoperative hours in 51.9% of the cases. Conclusion. The AIMS described above is sufficient in documenting the entire care process of patients in a day care unit. Integration into the existing AIMS was an important prerequisite for the integrity of the documentation chain. This allowed for a sensitive communication with other clinical data processing systems. The quality of documentation and flow of information at the workplaces in the day care unit were increased, similarly to other anaesthesiological workplaces in the hospital. Medical and administrative data and information for analyses of clinical processes are possible with such tools.