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Automated feedback modestly improves perioperative treatment adherence of postoperative nausea and vomiting
Extensive evidence demonstrates that medical record modernization and a vast amount of available data have not overcome the gap between recommended and delivered care. This study aimed to evaluate the use of clinical decision support (CDS) in conjunction with feedback (post-hoc reporting) to improve...
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| Published in: | Journal of clinical anesthesia 2023-06, Vol.86, p.111081-111081, Article 111081 |
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| container_end_page | 111081 |
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| container_title | Journal of clinical anesthesia |
| container_volume | 86 |
| creator | Gruss, Calvin L. Kappen, Teus H. Fowler, Leslie C. Li, Gen Freundlich, Robert E. McEvoy, Matthew D. Rothman, Brian S. Sandberg, Warren S. Wanderer, Jonathan P. |
| description | Extensive evidence demonstrates that medical record modernization and a vast amount of available data have not overcome the gap between recommended and delivered care. This study aimed to evaluate the use of clinical decision support (CDS) in conjunction with feedback (post-hoc reporting) to improve PONV medication administration compliance and postoperative nausea and vomiting (PONV) outcomes.
Single center, prospective observational study between January 1, 2015, and June 30, 2017.
Perioperative care at a university-affiliated tertiary care center.
57,401 adult patients who received general anesthesia in a non-emergency setting.
A multi-phased intervention that consisted of post-hoc reporting for individual providers by email about PONV occurrences in their patients, followed by directive CDS through preoperative daily case emails that provided therapeutic PONV prophylaxis recommendations based on patients' PONV risk scores.
Compliance with PONV medication recommendations, as well as hospital rates of PONV were measured.
Over the study period, there was a 5.5% (95% CI, 4.2% to 6.4%; p |
| doi_str_mv | 10.1016/j.jclinane.2023.111081 |
| format | article |
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Single center, prospective observational study between January 1, 2015, and June 30, 2017.
Perioperative care at a university-affiliated tertiary care center.
57,401 adult patients who received general anesthesia in a non-emergency setting.
A multi-phased intervention that consisted of post-hoc reporting for individual providers by email about PONV occurrences in their patients, followed by directive CDS through preoperative daily case emails that provided therapeutic PONV prophylaxis recommendations based on patients' PONV risk scores.
Compliance with PONV medication recommendations, as well as hospital rates of PONV were measured.
Over the study period, there was a 5.5% (95% CI, 4.2% to 6.4%; p < 0.001) improvement in the compliance of PONV medication administration along with an 8.7% (95% CI, 7.1% to 10.2%, p < 0.001) reduction in PONV rescue medication administration in the PACU. However, there was no statistically or clinically significant reduction in the prevalence of PONV in the PACU. The prevalence of PONV rescue medication administration decreased during the Intervention Rollout Period (odds ratio 0.95 [per month]; 95% CI, 0.91 to 0.99; p = 0.017), and during the Feedback with CDS Recommendation Period (odds ratio, 0.96 [per month]; 95% CI, 0.94 to 0.99; p = 0.013).
PONV medication administration compliance modestly improves with CDS in conjunction with post-hoc reporting; however, no improvement in PACU rates of PONV occurred.
•Audit and feedback, combined with a clinical decision support tool, modestly improves compliance with PONV recommendations.•Audit and feedback, combined with a clinical decision support tool, did not reduce the prevalence of PONV in the PACU.•Audit and feedback, alone, do not improve compliance with PONV prophylaxis recommendations.•Compliance with PONV recommendations improved by 5.5%; there was an 8.7% reduction in rescue medication use in the PACU.</description><identifier>ISSN: 0952-8180</identifier><identifier>EISSN: 1873-4529</identifier><identifier>DOI: 10.1016/j.jclinane.2023.111081</identifier><identifier>PMID: 36812833</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Anesthesia ; Anesthesia, General ; Antiemetics ; Antiemetics - therapeutic use ; Automation ; Clinical outcomes ; Data warehouses ; Decision making ; Disease prevention ; Documentation ; Drug administration ; Electronic health records ; Electronic mail systems ; Feedback ; Humans ; Informatics ; Intervention ; Medical personnel ; Narcotics ; Nausea ; Patient compliance ; Patients ; Postoperative Nausea and Vomiting - drug therapy ; Postoperative Nausea and Vomiting - epidemiology ; Postoperative Nausea and Vomiting - prevention & control ; Postoperative period ; Regression analysis ; Risk assessment ; Risk Factors ; Variables ; Vomiting</subject><ispartof>Journal of clinical anesthesia, 2023-06, Vol.86, p.111081-111081, Article 111081</ispartof><rights>2023</rights><rights>Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited Jun 2023</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-ae566a1fe4e064acccac8f6365ac5e3abab5cb3e80a7f437f5485683404b41a03</citedby><cites>FETCH-LOGICAL-c396t-ae566a1fe4e064acccac8f6365ac5e3abab5cb3e80a7f437f5485683404b41a03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36812833$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gruss, Calvin L.</creatorcontrib><creatorcontrib>Kappen, Teus H.</creatorcontrib><creatorcontrib>Fowler, Leslie C.</creatorcontrib><creatorcontrib>Li, Gen</creatorcontrib><creatorcontrib>Freundlich, Robert E.</creatorcontrib><creatorcontrib>McEvoy, Matthew D.</creatorcontrib><creatorcontrib>Rothman, Brian S.</creatorcontrib><creatorcontrib>Sandberg, Warren S.</creatorcontrib><creatorcontrib>Wanderer, Jonathan P.</creatorcontrib><title>Automated feedback modestly improves perioperative treatment adherence of postoperative nausea and vomiting</title><title>Journal of clinical anesthesia</title><addtitle>J Clin Anesth</addtitle><description>Extensive evidence demonstrates that medical record modernization and a vast amount of available data have not overcome the gap between recommended and delivered care. This study aimed to evaluate the use of clinical decision support (CDS) in conjunction with feedback (post-hoc reporting) to improve PONV medication administration compliance and postoperative nausea and vomiting (PONV) outcomes.
Single center, prospective observational study between January 1, 2015, and June 30, 2017.
Perioperative care at a university-affiliated tertiary care center.
57,401 adult patients who received general anesthesia in a non-emergency setting.
A multi-phased intervention that consisted of post-hoc reporting for individual providers by email about PONV occurrences in their patients, followed by directive CDS through preoperative daily case emails that provided therapeutic PONV prophylaxis recommendations based on patients' PONV risk scores.
Compliance with PONV medication recommendations, as well as hospital rates of PONV were measured.
Over the study period, there was a 5.5% (95% CI, 4.2% to 6.4%; p < 0.001) improvement in the compliance of PONV medication administration along with an 8.7% (95% CI, 7.1% to 10.2%, p < 0.001) reduction in PONV rescue medication administration in the PACU. However, there was no statistically or clinically significant reduction in the prevalence of PONV in the PACU. The prevalence of PONV rescue medication administration decreased during the Intervention Rollout Period (odds ratio 0.95 [per month]; 95% CI, 0.91 to 0.99; p = 0.017), and during the Feedback with CDS Recommendation Period (odds ratio, 0.96 [per month]; 95% CI, 0.94 to 0.99; p = 0.013).
PONV medication administration compliance modestly improves with CDS in conjunction with post-hoc reporting; however, no improvement in PACU rates of PONV occurred.
•Audit and feedback, combined with a clinical decision support tool, modestly improves compliance with PONV recommendations.•Audit and feedback, combined with a clinical decision support tool, did not reduce the prevalence of PONV in the PACU.•Audit and feedback, alone, do not improve compliance with PONV prophylaxis recommendations.•Compliance with PONV recommendations improved by 5.5%; there was an 8.7% reduction in rescue medication use in the PACU.</description><subject>Adult</subject><subject>Anesthesia</subject><subject>Anesthesia, General</subject><subject>Antiemetics</subject><subject>Antiemetics - therapeutic use</subject><subject>Automation</subject><subject>Clinical outcomes</subject><subject>Data warehouses</subject><subject>Decision making</subject><subject>Disease prevention</subject><subject>Documentation</subject><subject>Drug administration</subject><subject>Electronic health records</subject><subject>Electronic mail systems</subject><subject>Feedback</subject><subject>Humans</subject><subject>Informatics</subject><subject>Intervention</subject><subject>Medical personnel</subject><subject>Narcotics</subject><subject>Nausea</subject><subject>Patient compliance</subject><subject>Patients</subject><subject>Postoperative Nausea and Vomiting - drug therapy</subject><subject>Postoperative Nausea and Vomiting - epidemiology</subject><subject>Postoperative Nausea and Vomiting - prevention & control</subject><subject>Postoperative period</subject><subject>Regression analysis</subject><subject>Risk assessment</subject><subject>Risk Factors</subject><subject>Variables</subject><subject>Vomiting</subject><issn>0952-8180</issn><issn>1873-4529</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNqFkU1P3DAQhq0KVLbQv7CyxIVLFjt2HOdWhGiphMQFztbEmbQOSby1nZX49_VqWSpx6WXmMM98vS8ha842nHF1PWwGO7oZZtyUrBQbzjnT_BNZcV2LQlZlc0JWrKnKQnPNzsiXGAfGWC7wz-RMKM1LLcSKvNwsyU-QsKM9YteCfaGT7zCm8ZW6aRv8DiPdYnA-B0huhzQFhDThnCh0vzHgbJH6nm59TP-gGZaIQGHu6M5PLrn51wU57WGM-PUtn5Pn73dPt_fFw-OPn7c3D4UVjUoFYKUU8B4lMiXBWgtW90qoCmyFAlpoK9sK1AzqXoq6r6SulBaSyVZyYOKcXB3m5uv_LPkVM7locRyzWn6JpqzrRsimrnVGLz-gg1_CnK_LlGa1EJKrTKkDZYOPMWBvtsFNEF4NZ2ZvhxnM0Q6zt8Mc7MiN67fxSzth99521D8D3w4AZj12DoOJ1u0F7VxAm0zn3f92_AUrhqFM</recordid><startdate>202306</startdate><enddate>202306</enddate><creator>Gruss, Calvin L.</creator><creator>Kappen, Teus H.</creator><creator>Fowler, Leslie C.</creator><creator>Li, Gen</creator><creator>Freundlich, Robert E.</creator><creator>McEvoy, Matthew D.</creator><creator>Rothman, Brian S.</creator><creator>Sandberg, Warren S.</creator><creator>Wanderer, Jonathan P.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202306</creationdate><title>Automated feedback modestly improves perioperative treatment adherence of postoperative nausea and vomiting</title><author>Gruss, Calvin L. ; Kappen, Teus H. ; Fowler, Leslie C. ; Li, Gen ; Freundlich, Robert E. ; McEvoy, Matthew D. ; Rothman, Brian S. ; Sandberg, Warren S. ; Wanderer, Jonathan P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-ae566a1fe4e064acccac8f6365ac5e3abab5cb3e80a7f437f5485683404b41a03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Anesthesia</topic><topic>Anesthesia, General</topic><topic>Antiemetics</topic><topic>Antiemetics - therapeutic use</topic><topic>Automation</topic><topic>Clinical outcomes</topic><topic>Data warehouses</topic><topic>Decision making</topic><topic>Disease prevention</topic><topic>Documentation</topic><topic>Drug administration</topic><topic>Electronic health records</topic><topic>Electronic mail systems</topic><topic>Feedback</topic><topic>Humans</topic><topic>Informatics</topic><topic>Intervention</topic><topic>Medical personnel</topic><topic>Narcotics</topic><topic>Nausea</topic><topic>Patient compliance</topic><topic>Patients</topic><topic>Postoperative Nausea and Vomiting - drug therapy</topic><topic>Postoperative Nausea and Vomiting - epidemiology</topic><topic>Postoperative Nausea and Vomiting - prevention & control</topic><topic>Postoperative period</topic><topic>Regression analysis</topic><topic>Risk assessment</topic><topic>Risk Factors</topic><topic>Variables</topic><topic>Vomiting</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gruss, Calvin L.</creatorcontrib><creatorcontrib>Kappen, Teus H.</creatorcontrib><creatorcontrib>Fowler, Leslie C.</creatorcontrib><creatorcontrib>Li, Gen</creatorcontrib><creatorcontrib>Freundlich, Robert E.</creatorcontrib><creatorcontrib>McEvoy, Matthew D.</creatorcontrib><creatorcontrib>Rothman, Brian S.</creatorcontrib><creatorcontrib>Sandberg, Warren S.</creatorcontrib><creatorcontrib>Wanderer, Jonathan P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gruss, Calvin L.</au><au>Kappen, Teus H.</au><au>Fowler, Leslie C.</au><au>Li, Gen</au><au>Freundlich, Robert E.</au><au>McEvoy, Matthew D.</au><au>Rothman, Brian S.</au><au>Sandberg, Warren S.</au><au>Wanderer, Jonathan P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Automated feedback modestly improves perioperative treatment adherence of postoperative nausea and vomiting</atitle><jtitle>Journal of clinical anesthesia</jtitle><addtitle>J Clin Anesth</addtitle><date>2023-06</date><risdate>2023</risdate><volume>86</volume><spage>111081</spage><epage>111081</epage><pages>111081-111081</pages><artnum>111081</artnum><issn>0952-8180</issn><eissn>1873-4529</eissn><abstract>Extensive evidence demonstrates that medical record modernization and a vast amount of available data have not overcome the gap between recommended and delivered care. This study aimed to evaluate the use of clinical decision support (CDS) in conjunction with feedback (post-hoc reporting) to improve PONV medication administration compliance and postoperative nausea and vomiting (PONV) outcomes.
Single center, prospective observational study between January 1, 2015, and June 30, 2017.
Perioperative care at a university-affiliated tertiary care center.
57,401 adult patients who received general anesthesia in a non-emergency setting.
A multi-phased intervention that consisted of post-hoc reporting for individual providers by email about PONV occurrences in their patients, followed by directive CDS through preoperative daily case emails that provided therapeutic PONV prophylaxis recommendations based on patients' PONV risk scores.
Compliance with PONV medication recommendations, as well as hospital rates of PONV were measured.
Over the study period, there was a 5.5% (95% CI, 4.2% to 6.4%; p < 0.001) improvement in the compliance of PONV medication administration along with an 8.7% (95% CI, 7.1% to 10.2%, p < 0.001) reduction in PONV rescue medication administration in the PACU. However, there was no statistically or clinically significant reduction in the prevalence of PONV in the PACU. The prevalence of PONV rescue medication administration decreased during the Intervention Rollout Period (odds ratio 0.95 [per month]; 95% CI, 0.91 to 0.99; p = 0.017), and during the Feedback with CDS Recommendation Period (odds ratio, 0.96 [per month]; 95% CI, 0.94 to 0.99; p = 0.013).
PONV medication administration compliance modestly improves with CDS in conjunction with post-hoc reporting; however, no improvement in PACU rates of PONV occurred.
•Audit and feedback, combined with a clinical decision support tool, modestly improves compliance with PONV recommendations.•Audit and feedback, combined with a clinical decision support tool, did not reduce the prevalence of PONV in the PACU.•Audit and feedback, alone, do not improve compliance with PONV prophylaxis recommendations.•Compliance with PONV recommendations improved by 5.5%; there was an 8.7% reduction in rescue medication use in the PACU.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36812833</pmid><doi>10.1016/j.jclinane.2023.111081</doi><tpages>1</tpages></addata></record> |
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| identifier | ISSN: 0952-8180 |
| ispartof | Journal of clinical anesthesia, 2023-06, Vol.86, p.111081-111081, Article 111081 |
| issn | 0952-8180 1873-4529 |
| language | eng |
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| source | ScienceDirect Journals |
| subjects | Adult Anesthesia Anesthesia, General Antiemetics Antiemetics - therapeutic use Automation Clinical outcomes Data warehouses Decision making Disease prevention Documentation Drug administration Electronic health records Electronic mail systems Feedback Humans Informatics Intervention Medical personnel Narcotics Nausea Patient compliance Patients Postoperative Nausea and Vomiting - drug therapy Postoperative Nausea and Vomiting - epidemiology Postoperative Nausea and Vomiting - prevention & control Postoperative period Regression analysis Risk assessment Risk Factors Variables Vomiting |
| title | Automated feedback modestly improves perioperative treatment adherence of postoperative nausea and vomiting |
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