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PubMed1998

[Our challenge in Kagoshima University Hospital--development of more useful clinical laboratory].

In 1995, we newly developed a clinical laboratory system equipped with an expert system, which was named HIPOCLATES (Hospital Intelligent POwers of Clinical Laboratory Automation Technology with Expert System). Since this system includes an expert system, we have been able to support diagnostic and therapeutic procedure in clinics and begin developing a "zonal verification method" and "early-stage DIC diagnosis support system". The former is one of the individual quality control methods and we have attempted to develop a test assurance system in HIPOCLATES using this method. The latter system is to diagnosis DIC in the early phase. Here, we introduce the detail of our project using HIPOCLATES. Following the introduction HIPOCLATES, we attempted to develop a highly integrated system in physiological examinations, and succeeded in establishment PLATON (Physiological LAboratory TOtal Network system) in 1997. Thereafter, we planned a graphic reporting system named GALIREO (Graphic Assistant Laboratory Informational REport Operating system). In GALIREO, we attempted to connect the Department of Clinical Laboratory, Ultrasonic waves test room, Fiberscope test room, Department of Pathology and Surgical center by computer network. Developing these computer network system in our clinical laboratory we want to create electronic medical record linking with THINK (HIS in our hospital). We plan to make these expert system and electronic medical record available to clinical staff via a network to realize evidence-based medicine (EBM) and utilize these to support treatment and education.

Clinical Laboratory Information Systems↗
PubMed1994

"Stockless" cost reduction in the operating room.

St. Paul-Ramsey Medical Center in St. Paul, MN became one of the first hospitals in the United States to initiate a "stockless" par level inventory system. Successes with stockless led the hospital to look at implementing it in the OR to achieve a reduction of expense to revenue. Materiel Management and Surgical Services discussed a number of issues relevant to implementing a stockless program, including product flow, accuracy and cost of case carts and preference cards, item pricing, committed usage of items brought into the system and establishment of a steering committee. Specific OR issues and practices required evaluation and adjustment, such as the routine use of emergency direct ordering. Information systems support was brought in and a products committee established to do education and oversee the program. Savings for 1993-94 were $185,146.

Cost Savings↗
PubMed1986

An anesthesia information system for monitoring and record keeping during surgical anesthesia.

We have developed an anesthesia information system (AIS) that supports the anesthesiologist in monitoring and recording during a surgical operation. In development of the system, emphasis was placed on providing an anesthesiologist-computer interface that can be adapted to typical situations during anesthesia and to individual user behavior. One main feature of this interface is the integration of the input and output of information. The only device for interaction between the anesthesiologist and the AIS is a touch-sensitive, high-resolution color display screen. The anesthesiologist enters information by touching virtual function keys displayed on the screen. A data window displays all data generated over time, such as automatically recorded vital signs, including blood pressure, heart rate, and rectal and esophageal temperatures, and manually entered variables, such as administered drugs, and ventilator settings. The information gathered by the AIS is presented on the cathode ray tube in several pages. A main distributor page gives an overall view of the content of every work page. A one-page record of the anesthesia is automatically plotted on a multicolor digital plotter during the operation. An example of the use of the AIS is presented from a field test of the system during which it was evaluated in the operating room without interfering with the ongoing operation. Medical staff who used the AIS imitated the anesthesiologist's recording and information search behavior but did not have responsibility for the conduct of the anesthetic.

Anesthesia Department, Hospital↗
PubMed2001

Mathematical modeling to define optimum operating room staffing needs for trauma centers.

BACKGROUND: Level II trauma centers may be verified (1999, American College of Surgeons Committee on Trauma) with an on-call operating room team if the performance-improvement program shows no adverse outcomes. Using queuing and simulation methodology, this study attempted to add a volume guideline. STUDY DESIGN: Data from 72 previously verified trauma centers identified multiple demographic factors, including specific information about the first trauma-related operation that was done between 11:00 PM and 7:00 AM each month for 12 consecutive months. RESULTS: The annual admissions averaged 1,477 for 37 Level I trauma centers, 802 for 28 Level II trauma centers, 481 for 4 Level III trauma centers, and 731 for 3 pediatric trauma centers. The annual admissions correlated with the number of operations done between 11:00 PM and 7:00 AM (p < 0.001). These 946 operations were performed by general surgery (39%), neurosurgery (8%), orthopaedic surgery (33%), another specialty (9%), or multiple services (10%). Admission to operation time was within 30 minutes for 12.1% of patients (2.6% for blunt and 24.1% for penetrating injuries). The probability of operation within 30 minutes of arrival varied with the number of admissions and with the percentage of penetrating versus blunt injuries. The likely number of operations from 11:00 PM to 7:00 AM would be 19 for 500 annual admissions, 26 for 750 annual admissions, and 34 for 1,000 annual admissions, with 5.83, 7.98, and 10.13 patients, respectively, going to operation within 30 min. The probability that two rooms would be occupied simultaneously was 0.14 and 0.24 for centers admitting 500 and 1,000 patients, respectively. CONCLUSIONS: Trauma centers performing fewer than six operations between 11:00 PM and 7:00 AM per year could conserve resources by using an immediately available on-call team, with responses monitored by the performance-improvement program.

Guidelines as Topic↗
PubMed2005

End-tidal carbon dioxide monitoring in pediatric emergencies.

End-tidal carbon dioxide (CO2) monitoring is useful in the prehospital setting, emergency department, intensive care unit, and operating room. Capnography provides valuable, timely information about the function of both the cardiovascular and respiratory systems. End-tidal CO2 monitoring is the single most useful method in confirming endotracheal tube position. It also provides information about dead space, cardiac output, and airway resistance. A thorough understanding of cardiopulmonary physiology and the technical nuances of capnometry is required for its optimal use in children. This review examines the basic physiology pertinent to end-tidal CO2 monitoring, its clinical applications, and evidence supporting its use in infants and children.

Capnography↗
PubMed2007

Integrating incident reporting into an electronic patient record system.

Developments in information technology offer new opportunities to design electronic patient record systems (EPR) which integrate a broad range of functions such as clinical decision support, order entry, or electronic alerts. It has been recently suggested that EPR could support new applications for disease surveillance and patient safety. We describe the integration of a voluntary incident reporting system into an EPR used in operating theatres, to allow the reporting of accidents and preventable complications. We assessed system's reliability and users' acceptance. During the 4-years observation period (2002-2006), 48,983 interventional procedures were performed. Clinicians documented 85.1% of procedures on the incident reporting form. Agreement between chart review and electronically reported incidents was 80.6%. The integration of an incident reporting system into an EPR is reliable and well supported by health care professionals.

Adult↗
PubMedDate not supplied

The making of a multipurpose, OR-ready, angiography/interventional cath lab suite.

The field of clinical cardiology is now poised to benefit from recent technological advances. Potential for expanding services, increasing productivity, and controlling costs is now awaiting the clinical cardiology. At the same time, certain treatment therapies once addressed exclusively through surgery are being replaced by less invasive procedures performed by interventional cardiologists and radiologists as well as surgeons.

Angiography↗
PubMedDate not supplied

[Monitoring in surgery and resuscitation: current state, problems, and trends].

General problems of medical monitoring are discussed using monitoring in anesthesiology and resuscitation as an example. The current state of this important problem of biomedical engineering and perspectives of its further development based on sophisticated medical methods of measurement of vitally important parameters of patient are analyzed. The main emphasis was placed on the problems of collaboration between physicians and engineers in the development of monitoring systems and optimal information support of physicians during the use of monitoring systems in surgery and resuscitation. Special attention was devoted to facilitation of working conditions of physician with due regard to patient safety. The problems of appearance of monitoring errors, their origin, and approaches to their minimization are also discussed.

Anesthesiology↗
PubMed1994

Development of a user-defined surgical database using a personal computer network.

Advances in personal computer technology have made powerful methods for the collection and analysis of patient information available to clinical users. This report details the development of a multi-user database distributed across a network of personal computers that facilitates operative scheduling, and collection and analysis of operative data. Clinicians from each surgical service in our medical center developed customized data entry programs that contribute information centrally through a telephone-line network to prepare the daily operative schedule. Subsequently, information from the operating rooms is added to the preoperative database to form an operative log, which is distributed to client services for further analysis and modification. This system has improved the efficiency and accuracy of operative scheduling and information management and shifted the burden of data collection away from the physician. Widespread availability of these data has contributed to the development of an effective quality improvement program and facilitated effective management of personnel and resources.

Computer Communication Networks↗
PubMed1989

Interactive microcomputer for acquisition of patient information.

Written records and first-generation hospital information systems do not meet their primary purpose to assist physicians in solving patients' problems. Simply automating the present chart formats is not the answer. An example of the concept needed for charting is the intensive care unit chart. Anesthesiology charts provide little useful information for the continued care of the patient postoperatively. They serve principally as legal archival documents. Automation of the anesthesia record should free the anesthesiologist of the need to search for preoperative information and to manually record most information intraoperatively. Decisions about how much data to archive and how to extract the data pertinent to continuing care are the challenges for physicians. The technologic tools are available for the design and implementation of a software system that focuses on effective communication of the patient's problems throughout the perioperative period as the patient moves from ward to operating room, through the recovery room and intensive care unit, and to the ward and home.

Anesthesiology↗
PubMed1996

Automatic record keeping in anaesthesia--a nine-year Italian experience.

In 1986, in Buccheri La Ferla Hospital, Palermo, an anaesthesia information management project was started. Its aim was to develop a computerized anaesthesia workstation. Today, the system is in daily clinical use and has reached most of its original goals: Automatic collection of physiological signals and patient monitor trends is possible by means of analog-digital conversion or by using serial data transfer. A centralized display is included in the system to allow easy control of the progress of the anaesthetic procedures in the hospital. Available in the workstation, there is an on-line help function to assist pharmacological calculations and administration of anaesthesia drugs. Mail messages can be sent to different anaesthesia workstations and data can be shared between them. Information collected during preoperative visits is automatically transferred from a portable personal computer to the system. There is a nine-year patient data-base with both preoperative and perioperative anaesthesia information which can be accessed from each of the workstations. Today, the system is in daily routine use and comprises eight anaesthesia workstations and two portable personal computers used for preoperative visits. The operation schedule with anaesthetists' notes is printed both for surgical wards and for O.R., using information stored from preoperative visits to the system. For automated data collection a trend resolution of one minute has been used. The postoperative orders are printed from the system in the recovery room and given to the wards with the patient. The feedback from the seventeen anaesthetists and twenty-four nurses who use the system routinely is positive. Today, 16,000 patient records are available in the database. This number increases by 3,300 every year. With increasing computer utilization in patient treatment there have been no legal or administrative controversies. Based on nine years' experience, it is clear that the use of computers in anaesthesia practice improves quality of patient care.

Analog-Digital Conversion↗
PubMed2006

A novel point-of-care information system reduces anaesthesiologists' errors while managing case scenarios.

BACKGROUND AND OBJECTIVES: The On-Line Electronic Help (OLEH) is a point-of-care information system for anaesthesia providers prepared by the European Society of Anaesthesiologists. In this preliminary study the effect of the OLEH availability on the incidence of knowledge-based errors during the management of case scenarios and participants' subjective evaluation of the OLEH were evaluated. METHODS: After a short training session, 48 anaesthesiologists (24 junior residents, 12 senior residents and 12 board-certified) were presented randomly with six computer screen-based case scenarios with, and six without, the option of using the OLEH. Two reviewers evaluated the answers independently according to preconfigured guidelines. RESULTS: The availability of the OLEH was associated with higher scores in 11 of the 12 scenarios, and with a decrease in the incidence of critical errors in 10 scenarios. Time to task completion was increased in one scenario only when the OLEH was used. The degree of professional experience was associated with better scores in five of the scenarios and with a reduced occurrence of critical errors in three scenarios. Forty-two out of 48 participants stated that finding information in the OLEH software was easy and that the system was helpful in managing the scenarios. CONCLUSIONS: This preliminary study demonstrates the potential value of the OLEH in decreasing the number of knowledge-based errors made by anaesthesiologists. According to the encouraging results, the OLEH system is currently under evaluation using full-scale simulation scenarios in an operating room environment.

Anesthesia↗
PubMed1991

[Continuous blood gas monitoring in intensive care units].

The measurement of O2 and CO2 transport in the arterial and venous mixed blood constitutes the intersection between haemodynamic data and expiratory-inspiratory gases. The arterial-venous difference in O2 (a-v-DO2) and the venous arterial difference in CO2 (v-a-DCO2) calculated from the data of PA, PO2, PCO2 (read by an ABL4 Radiometer) revealed a close correlation with a a-v-DO2 measured directly by means of the LEXO2 (r = 0.99) or with VCO2 measured in expired gases by a capnograph (r = 0.99). In heart surgery the "on-line" monitoring of VCO2, a-v-DO2 and related parameters (REE = Resting Energy Expenditure) in the operating room and in ICU by means of a PDMS (Patients Data Management System) provides very useful information which, when integrated with haemodynamic parameters, allows a better understanding and better care of critical patients.

Blood Gas Monitoring, Transcutaneous↗
PubMed1991

An evaluation of an automated anesthesia record keeping system.

Mayo Clinic makes use of an automated anesthesia record keeping system in its cardiovascular operating rooms. Over 20,000 anesthesia records have been recorded with this system since its installation in 1983. How successful is this system? Does it meet the needs of the anesthesiologist? What are their attitudes towards the computer? A questionnaire survey was conducted to solicit the experiences, opinions, and recommendations of the users of this system. The results are described in this paper. The feedback will be used to determine the tasks and their priority for improving the current system, and to define the requirements for future computerization to meet the needs of the anesthesiologist in the operating room.

Anesthesiology↗
PubMed2002

OR automation systems.

An operating room (OR) automation system is a combination of hardware and software designed to address efficiency issues in the OR by controling multiple devices via a common interface. Systems range from the relatively basic--allowing control of a few devices within a single OR--to advanced designs that are capable of not only controlling a wide range of devices within the OR but also exchanging information with remote locations.

Automation↗
PubMed1980

The hemodynamic tracking system: a method of data management and guide for cardiovascular therapy.

In the operating room or intensive care unit, multiple measurements of circulatory function are almost mandatory in patients with significant cardiovascular disease. Use in these areas requires that the information must be easily organized, rapidly obtained, and inexpensive. A hemodynamic tracking system that meets these criteria is described. This system incorporates a hand-held programmable calculator (cost = $210 to $300) to derive variables computed from standard cardiovascular measurements. The time required to obtain a set of measurements (including thermodilution cardiac output determinations in duplicate), key the numbers into the calculator, and obtain the derived indices is 4 minutes. Two patients, who had acute mitral insufficiency and whose clinical management differed substantially are presented to illustrate the use of data obtained from the hemodynamic tracking system.

Aged↗
PubMed2002

A simple device for measuring the resolution of videoscopic cameras and laparoscopes in the operating room.

BACKGROUND: There is a need for a device that can be used to objectively evaluate the image quality provided by laparoscopic camera units in the operating room. METHODS: The device that we developed consists of a regular 10-mm or 5-mm laparoscopic port with a rectangular test unit built at the end. A standard test pattern slide with resolution bars is used for measurements. Using this assembly, a single-chip laparoscopic camera was compared with a three-chip laparoscopic camera at different wiring formats and camera settings by measuring the resolution on the monitor screen. RESULTS: Vertical resolution was found to be constant at 550 lines, regardless of the type of camera and wiring used. Of the three wiring formats, composite wiring provided the poorest image with both cameras. When enhancement was off, the horizontal resolution obtained with Y/C or RGB wiring was the same for the one-chip camera at 640 lines of horizontal resolution, whereas RGB cabling provided the best image for the three-chip camera at 800 lines. CONCLUSION: Using basic broadcasting principles, we have developed a simple device that is useful for the comparison of different camera, cabling, and laparoscope configurations in the operating room. This information can be used as objective criteria to judge the image quality in laparoscopic video- systems.

Humans↗