Background: Although most patients who undergo elective surgery chose to do so in order to cure conditions or improve quality of life, approximately 1 in 50 surgical patients will die within one month of their operation. The incidence of major morbidity (e.g. myocardial infarction, stroke, renal failure) is even higher. Many factors contribute to this morbidity and mortality, some of which are not easily addressed (e.g. preexisting comorbid conditions, patient frailty, invasiveness of surgery). In contrast, there are modifiable intraoperative factors (e.g. late administration of antibiotics, hypothermia, hemodynamic instability) that are likely to be associated with increased postoperative complications. Yet, no study has evaluated the potential of leveraging information technology (IT) to systematically address candidate quality of care metrics to mitigate negative outcomes. This study will be the first randomized controlled study of an air-traffic control-like command center for the operating suite, and is designed to enhance surgical outcomes by developing forecasting algorithms and by implementing evidence-based approaches to modifiable perioperative risk factors.
Specific aims : This pilot study will implement an Anesthesiology Control Tower (ACT), and will achieve the following: (i) develop, refine and validate forecasting algorithms for adverse outcomes; (ii) Assess the usability of an ACT for the operating suite; and (iii) assess whether the ACT improves clinician compliance with standards of care and surrogate measures of patient outcomes. Innovative Health Information Technology Intervention: This pilot study will employ the existing information technology infrastructure at Barnes Jewish Hospital to create a remote monitoring and alerting system for the operating rooms. Few IT interventions are rigorously tested in practice using a randomized design. Similar to ?telemedicine? methods employed in critical care, the ACT will support operating room clinicians in adhering to best-practice principles. The design for this pilot proof-of-concept study is a 6-month pre-intervention period, during which the ACT will be set up, forecasting algorithms will be developed, and ACT protocols will be fine tuned. This will be followed by a one year randomized controlled evaluation. During the trial, ACT physicians will monitor, in real time, surgical cases at Barnes Jewish Hospital, providing supplemental alerts and support to physicians in randomized operating rooms. The forecasting algorithms will also be validated and refined. The usefulness and usability of the ACT will continuously be assessed over the course of the study. Implications: The successful implementation of evidence-based medicine is an ongoing struggle in healthcare. This work could have a major impact on healthcare if it demonstrates that successful implementation of an ACT promotes quality improvement and the realization of the latest advances in perioperative medicine, enhancing surgical patient safely, while simultaneously increasing efficiency.

Public Health Relevance

(2-3 sentences describing the relevance of the research to public health) Postoperative morbidity and mortality is a major public health problem. Of the over 200 million people around the world who undergo elective surgery each year, 1-5% will die within 30 days of surgery, and about 10% to 20% will experience major complications, such as heart attacks, unremitting pain, infections and blood clots, in the weeks to months following their procedures. This pilot study will institute an air-traffic control-like command center to facilitate increased adherence to best-practice principles and superior intraoperative care, ultimately improving postoperative quality of recovery and patient outcomes.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Exploratory/Developmental Grants (R21)
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Healthcare Information Technology Research (HITR)
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Hsiao, Janey
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Washington University
Schools of Medicine
Saint Louis
United States
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