In Gastrointestinal endoscopy ; h5-index 72.0
BACKGROUND AND AIMS : Nearly all routine endoscopy procedures are performed using moderate sedation (MS) or monitored anesthesia care (MAC). In this article, we describe how we improved decision-making and decreased practitioners' cognitive burden for choosing between MAC and MS by utilizing patient data in an automated application within the electronic health record (EHR).
METHODS : In our practice, we choose between MS or MAC for routine gastrointestinal (GI) procedures according to written anesthesia use guidelines and practitioner preferences. To expedite our decision-making for MS vs MAC, we developed an Excel-based tool from patient demographic characteristics, comorbid conditions, and medication use extracted from the EHR. The data points from Excel were then implemented in the automated application in the EHR to predict the type of sedation for GI procedures.
RESULTS : Before use of the new application, nurses spent an average of 4 minutes and gastroenterology practitioners spent 5 minutes reviewing the EHR to determine the appropriate sedation (MS or MAC). After the application was implemented, the use of MS substantially increased. Time spent reviewing the EHR was reduced to 2 minutes. The rate of adverse events for MS (0.5%) vs MAC (0.6%) was comparable and low overall.
CONCLUSIONS : The EHR-based application, which automates and standardizes determination of sedation type, is a highly beneficial tool that eliminates subjectivity in decision-making, thus allowing for appropriate use of MAC. Complication rates and sedation failure did not increase with use of the application. With the increase in use of MS over MAC, health care costs for the more expensive MAC sedation should also decrease.
Garg Sushil Kumar, Szymoniak Amy M, Johnson Karen F, Vaughn Jackqueline K, Seelman John J, Degen Susanne C, Chaudhry Rajeev
2023-Feb-06
automated application, electronic health record, endoscopy, implementation, sedation
