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A Junger

Publications and source records attributed to A Junger.

47 records · Page 3Linked to original sources
PubMed2000

Data processing at the anesthesia workstation: from data entry to data presentation.

Main requirements for an Anesthesia Information Management System (AIMS) are the supply of additional information for the anesthesiologist at his workstation and complete documentation of the anesthetic procedure. With the implementation of an AIMS (NarkoData) and effective user support, the quality of documentation and the information flow at the anesthesia workstation could be increased. Today, more than 20,000 anesthesia procedures are annually recorded with the AIMS at 112 decentralized workstations. The network for data entry and the presentation and evaluation of data, statistics and results directly available at the clinical workstation was made operational.

Anesthesia↗
PubMed1999

[Quality documentation with an Anaesthesia Information Management System (AIMS)].

OBJECTIVE: In 1994 the Department of Anaesthesiology and Intensive Care Medicine of the Justus Liebig University of Giessen decided to implement an Anaesthesia Information Management System (AIMS) to replace the previous hand-written documentation on paper. From 1997 until the end of 1998 the data sets of 41,393 anaesthesia procedures were recorded with the help of computers and imported into a data bank. Individual aspects and results of this data pool are presented under the aspect of how the system in its present form is able to guarantee documentation of quality according to the requirements of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI). METHODS: Since 1997 information on all anaesthesia procedures has been documented "online" with the anaesthesia documentation software NarkoData 4 (ProLogic GmbH, Erkrath). The data sets have been stored in a relational data bank (Oracle Corporation) and statistically processed with the help of the SQL-based program Voyant (Brossco Systems, Espoo, Finland). As an example of two adverse perioperative events (AVB) we compared incidences of "hypotension" and "nausea/vomiting", recorded by staff members into the AIMS, with the incidence of comparable events that were recorded with the help of online data during anaesthesia procedures, such as blood pressure and drug application. Since 1998 data recording has been revised constantly in department meetings; advanced training has been given. The results have been analysed critically. RESULTS: In 1997 the incidence of adverse perioperative events entered manually into the system was 3.6% (grade III and higher 0.9%) and increased during 1998 to 22.2% (grade III and higher 1.9%). The frequency of anaesthesia procedures with manually documented AVBs was significantly below the incidence (determined with the help of online data) of comparable events: "hypotension" (1.8% vs. 8.5%) and "nausea/vomiting" (4.9% vs. 8.3%). CONCLUSION: The current documentation of AVBs in almost any hospital is incomplete. In contrast to the hand-written procedure, the AIMS provides recorded data for evaluation and guarantees more detailed and complete quality documentation. In addition, the effort needed for documentation is reduced. Whether these data sets really describe and measure quality or not has to be evaluated. In addition it has to be considered whether different requirements (such as automatic AVB recognition for an AIMS) are advantageous for quality documentation regarding the data raster and the AVB recognition, with respect to different documentation procedures.

Anesthesia↗
PubMed1999

[Intraoperative blood requirements and allogeneic blood transfusion in cardioanesthesia. Data analysis of 7729 patients in 12 cardiac surgical clinics].

UNLABELLED: Allogeneic blood requirements in cardiac surgery shows a wide variation even for comparable procedures. The aim of the present study was to compare the intraoperative allogeneic blood requirement in defined cardiac operations among 12 cardiac centers in Germany. METHOD: A data set with 25 variables concerning the intraoperative course in adult cardiac patients with myocardial revascularization, valve replacement (aortic or/and mitral valve) or combined procedures was distributed to the participating centers. The data of all patients between January 1th 1998 and June 30th 1998 were included. Besides demographic data, the intraoperative transfusion of allogeneic and autologous blood, fresh frozen plasma and the concomitant hematocrit values were registered. Data were analyzed for all centers and separated for each center. RESULTS: The data of 7,729 patients were analyzed. The intraoperative allogeneic blood requirement was 0.6 +/- 1.3 units for all patients. It varied among the centers from 0.25 +/- 0.6 units to 0.97 +/- 1.6 units (P < 0.05). The percentage of patients receiving allogeneic blood was 27% and differed among the centers from 17% to 35%. Female patients were transfused in 53% (36-39%) compared to male patients with 16% (9-20%) (P < 0.05). The rate of autologous blood predonation varied from 0.5% to 23%. Patients without autologous predonation were transfused in 28% compared to 4% in patients with predonation (P < 0.05). In patients with autologous predonation the intraoperative transfusion of allogeneic blood was significantly reduced (0.1 +/- 0.39 vs 0.6 +/- 1.4 units, P < 0.05). However, some centers with a high percentage of autologous predonation also demonstrated a high rate of perioperative allogeneic transfusion. CONCLUSION: The incidence of allogeneic blood transfusion in cardiac surgery depends on the institution and not on the surgical procedure. A common threshold value of hemoglobin for the transfusion of blood trigger even for comparable procedures could not be detected among the centers. Especially in female patients, there was a wide variation in allogeneic blood transfusion. Autologous blood predonation reduces blood requirement significantly, however, it is practiced with variing intensity. The data set did not include information about transfusion regimen in the postoperative period, thus, these data do not allow to draw conclusions for the whole perioperative period.

Adult↗
PubMed1999

[Statistics and evaluation of a graphic SQL user interface in an anesthesia information management system (AIMS)].

PURPOSE: Since 1997, the Anaesthesia Information Management Systems (AIMS) in our department has produced extensive data material (DGAI core data, vital sign parameters, respiratory parameters, material consumed, etc.) which is stored in a relational data bank. The processing of this data by means of SQL queries was restricted to a few persons with special knowledge only. It was the objective of the project to create an evaluation tool which enables each member of the department to enter queries concerning topics such as efficiency records, quality management, training and research at any time. The tool was also intended to present results in an adequate form. METHODS: Since 1997, the data of the performed anaesthesia procedures have been recorded using the online anaesthesia documentation software NarkoData Version 4 (ProLogic GmbH, Erkrath) within the AIMS. The recorded data sets have been imported into a relational Oracle data bank (Oracle Corporation). The commercial programme Voyant (Brossco Systems, Espoo, Finland) enables for the user to formulate SQL-requests (Structured Query Language) with the help of a graphic user interface and to present the results in a variety of graphics and tables. Repetition of the evaluation using the current data is possible at any time. RESULTS: During 1997 and the first quarter of 1998, the data of 26,030 anaesthesia procedures have been registered and stored in the anaesthesiological data base. 235 queries could be formulated with the SQL-capable graphic tool Voyant. They are available to each member of the department by the application of NarkoStatistik (IMS GmbH, Giessen) within the AIMS, together with the corresponding documentation (HTML pages). The query catalogue covers the main topics of efficiency, quality management, organisation, diagnoses and surgery, pre-, intra- and postoperative data and day-care unit. Even without much previous experience with the system it is possible to carry out evaluations with the current data at selected AIMS terminals. Queries concerning other subjects can be created and can be integrated into the existing query catalogue. CONCLUSION: With the described application we are able to establish an evaluation tool which fulfils our expectations regarding user friendliness and the subjects the queries can cover. Today it has a central position within the AIMS. In addition to the anaesthesia documentation software and the data bank structure, the efficiency of an AIMS is mainly influenced by the corresponding evaluation tool.

Anesthesiology↗
PubMed1999

[Experiences fo three year's routine operation of an anesthesia information management system (AIMS) at a university clinic in Giessin].

PURPOSE: In 1994, the Department of Anaesthesiology and Intensive Care Medicine of the Justus Liebig University at Giessen decided to install an Anaesthesia Information Management System (AIMS). Individual aspects and results from routine operation are presented, demonstrating the quality of the documentation and the value of information at the anaesthesiological workstation. The paper discusses which adaptations are necessary according to the experience gathered. METHODS: For the installation of the system Apple Macintosh Clients (Apple Computer, Inc., Cupertino, California) and a File Server were integrated into the partially existing hospital network. The hospital network had to be enlarged during the project according to the Anaesthesiological requirements. The software of the Hospital Information System (HIS) and an HTML browser were installed at individual workstation computers in addition to the Anaesthesia documentation software NarkoData (ProLogic GmbH, Erkrath). The remote control software Timbuktu (Farallon, Alameda, USA) has been added to facilitate remote administration. The file administration programme FileWave (Wave Research, Berkeley, USA) is used for file distribution. Since 1995, all anaesthesia procedures have been documented with the system, either by online or postoperative recording. Since 1997, the recorded information has been stored in a relational Oracle 7 data bank (Oracle Corporation). RESULTS: From 1995 to 1997, 60,405 anaesthesiological procedures have been recorded with the help of this AIMS at 111 decentralised workstations. In 1997, 87.8% of the 21,130 performed anaesthesia procedures have been recorded online with the system and 12.2% postoperatively. From 1995 to 1997, the number of recorded procedures increased by 6.4% from 19,854 to 21,130. Because of lacking interfaces at some patient monitoring stations, the automatic recording of patient data could only be implemented at 69 workstations (62%). With the corresponding access rights, important patient information from the HIS (diagnoses, laboratory results, etc.), records of previous Anaesthesia procedures, numerous statistics, and the whole information from the hospital's intranet (including e-mail) are available at the anaesthesiological workstation at any time. CONCLUSION: The implementation of the AIMS and an effective user support have been able to increase significantly the quality of documentation, the flow of information at the anaesthesia workplace and the number of recorded Anaesthesia procedures. All recorded data can be analysed immediately The expansion of the automatic data transfer from the patient monitoring, interfaces to other computer subsystems of the hospital and a practicable evaluation programme are necessary for further enhancing the efficiency of the AIMS.

Anesthesiology↗
PubMed1999

[Aspects of external quality assurance in anesthesiology--experiences in Hamburg].

In 1994, external quality assurance in anaesthesia according to the German Society of Anaesthesiology and Intensive Care (DGAI) was obligatory introduced in Hamburg. Since 1992 in a pilot project and since 1994 compulsory nearly 500,000 anaesthesias were documented by 39 institutions with a standard data set issued by the DGAI and transferred to the project office of the Association for Quality Assurance (EQS) Hamburg. Comparative statistics of these data were produced at the project office. In the controlling committee and in meetings of the project participants the contents, policy and results of the project were critically analyzed and adjustments initiated whenever necessary. With an incidence of 14.1% of all anaesthesias with special occurrences (AVB), the results are in the same range compared to most other studies. To evaluate the concept of documentation the predictory power of single and combined risk assessments for the incidence of particular AVBs in elective anaesthesias were compared to the predictory power of ASA-Classification in order to reduce the parameters that had to be collected. This should lead to a positive influence on the quality of documentation. Besides one exception, no superior prediction power for AVB incidence could be demonstrated for any special risk assessment as compared with the ASA-classification. This is also true for the AVBs which are associated with high lethality. Thus, the documentation of risk factors in the core data set as predictors can be abandoned without major loss of information. The participants consider the project to be a useful support for internal improvement projects. Besides the reduction of the amount of data in quality assurance to get a core of particularly meaningful parameters the classification of the surgical procedure by the ICPM- or OPS 301-Code should be integrated into the core data set of the DGAI. It would lead to an increase in acceptance of the method and thus to an increase in the validity of its results and valuations.

Anesthesiology↗
PubMed1998

[Four year's experience with quality assurance in anesthesiology in Hamburg].

PURPOSE: Since 1992 421,851 anaesthesias were documented by 39 institutes with a standard dataset issued by the German Society of Anaesthesiology and Intensive Care (DGAI). The project was run by the Association for Quality Assurance (EQS) in Hamburg. Some results of the evaluation of this datapool are presented questioning the feasibility of the project to support improvement processes within the participating institutions and which adjustments should be done considering these experiences. METHODS: Data from machine-readable protocols and documentation software representing all anaesthesia cases were recorded since 1992 in a pilot project and since 1994 compulsory with a standard dataset issued by the DGAI. Comparing statistics of these data was produced at the EQS project office. In the steering committee and in meetings of the project participants the contents, policy and results of the project office. In the steering committee and in meetings of the project were critically analysed and adjustments initiated whenever necessary. Validity of data and feasibility of the method used was also questioned on the background of comparable studies. RESULTS: With an incidence of 14.1% of all anaesthesias with special occurrences (AVB) the results are in the same range if compared with most other studies. However, documentation of data is not complete. This is assumed to be due to the large size of the dataset with 112 items and the additional workload associated with it. Nevertheless the participants mostly consider the project to be a very useful support for internal improvement projects. CONCLUSION: The project method used so far is not mature yet. The data set must be streamlined and rendered more concise, quality indicators should be defined and tested, and the availability of statistically proven limits of tolerance should be the immediate aims in the further development of the project.

Adult↗
PubMed1998

[Continuous improvement in anesthesiological quality documentation].

OBJECTIVE: The analysis of result variation in quality benchmarking projects in anaesthesia showed that ASA classification was often the most relevant parameter in distinction of risk groups. Thus the parallel description of the risk level of a patient both with the ASA classification and with particular risk parameters was examined critically. The hypothesis was tested that the documentation of both parameter groups in the running quality benchmarking projects does not lead to relevant information gain. As a pragmatic consequence we see the possibility to reduce the core dataset with significant reduction of the documentation workload. METHODS: With machine readable protocols or online computer documentation nearly all anaesthesias in hospitals in Hamburg were documented with the DGAI core data set and transferred to the project office of EQS Hamburg since 1992. We compared the predictory power of single and combined risk assessments for the incidence of particular AVBs (grade 3 to 5) in elective anaesthesias with that of ASA-classification. RESULTS: In 257,878 elective anaesthesias AVBs were documented in 14.5% of cases. Besides one exception no superior prediction power for AVB incidence could be demonstrated for any special risk assessment as compared with the ASA-classification. This is also true for the AVBs decompensated cardiac insufficiency, myocardial infarction, pulmonary embolism and cardiac arrest which are associated with high lethality. CONCLUSION: We assume that the documentation of risk factors in the core data set as predictors can be abandoned without major loss of information. This would be a first step towards reduction of the amount of data in quality assurance to get a core of especially meaningful parameters. It would lead to an increase in acceptance of the method and thus to an increase in the validity of its results.

Anesthesia↗