Anesthesia Management System: Smart and Saves Money

A cutting-edge anesthesia management system developed at the University of Washington (UW) Medical Center, in Seattle, has generated an estimated return of $1 million annually for the hospital while providing a major boost to patient care.

Bala Nair, PhD, associate professor of anesthesiology and pain medicine at UW, detailed the development of the new system and its impact on patient care and hospital revenue, during a presentation at the Society for Technology in Anesthesia’s annual meeting.

For example, the new Smart Anesthesia Manager (SAM) has resulted in a far more efficient use of expensive inhalation agents, Dr. Nair said.

Developed over the past five years by Dr. Nair with assistance from other medical center colleagues, SAM has also boosted clinical care. The use of SAM has significantly improved blood pressure, glucose and antibiotic management, resulting in greater compliance to institutional guidelines, Dr. Nair said. Other benefits include barcode verification of drugs at the time of administration and a “handoff tool,” particularly helpful for the transfer of care from anesthesia to nursing at the end of a procedure.

In addition to the UW Medical Center, SAM also has been installed at Harborview Medical Center, also in Seattle, and at Ochsner Medical Center, in New Orleans.

“Timing of notification is as critical as the decision rule itself. The strategy is to get the provider’s attention in a very optimal fashion without bombarding them with a lot of messages,” Dr. Nair said. “You have to balance that.”

Dr. Nair began developing SAM in 2009 as a way of building on existing technology that had proved to be limited in its utility. His idea was to build a support module for the Anesthesia Information Management System (AIMS), a documentation system that turned out to have limited ability to improve quality of care and revenue.

The new SAM system conveys a real-time stream of prompts and information, a major upgrade over AIMS, Dr. Nair said. That capability, in turn, has boosted revenue while enabling tighter monitoring on the clinical care side and improved quality of care.

“Real-time notification is effective in changing and sustaining provider behavior,” Dr. Nair said. “Data latency is a severe disadvantage.”

SAM’s Savings

SAM’s biggest bottom line impact has been in the use of gas. The system has resulted in far more efficient use of expensive inhalant agents, leading to reduction in use of sevoflurane, desflurane and isoflurane (28%, 33% and 12%, respectively). That change alone has saved the UW Medical Center an estimated $120,000 a year, Dr. Nair said.

More efficient bi lling has been another important benefit, he said. SAM captures charges for procedures that were previously missed through lack of supporting documentation, including some invasive line special procedures and physician attestations, Dr. Nair said. There also has been a significant improvement in billing accuracy and documentation compliance as well.

Meanwhile, patient care and safety also has improved. SAM has more than halved extended gaps in blood pressure monitoring at the UW Medical Center, from 15.7 instances per 1,000 cases to 6.7 instances, Dr. Nair said. Before SAM, the maximum gap in blood pressure monitoring was 64 minutes, but after the new system was installed, it dropped to 28 minutes.

The tighter monitoring had a big effect on patient care, with concurrent hypotensive–high anesthetic agent episodes dropping to 2.3 per 1,000 after SAM, whereas hypertensive episodes with concurrent phenylephrine infusions dropped from 30.3 to 21.1 per 1,000. The maximum hypotensive episode dropped from 44 to 15 minutes, whereas hypertensive episodes fell from 30 to 21 minutes after use of the new system.

The UW Medical Center also saw a major improvement in the rate of initial antibiotic dosing, with compliance rising to 99% from percentages in the 80s and low 90s previously, Dr. Nair said. Compliance rates on antibiotic redosing also climbed, from 62% before SAM to 95% after. Since using SAM, the hospital met the β-blocker Surgical Care Improvement Project measure 97% of the time compared with 62% before, he said.

Glucose management improved as well. The new system sends out prompts to “initiate glucose management,” perform “a preincision glucose measurement” and check glucose measurements hourly, Dr. Nair said. Glucose compliance—as measured by hourly glucose measurements and correct insulin adjustments—also rose significantly. Compliance with hourly glucose measurements rose to 81% with SAM notification from 53% without, Dr. Nair said.

Additionally, SAM also has proved helpful to clinicians dealing with unusually complex or rare cases. A prime example is pediatric traumatic brain injury cases, with SAM helping clinicians at the Harborview Medical Center stay on top of complicated care protocols.

Dr. Nair has also developed a “handoff tool” through SAM that can be used when transferring patient care from one provider to another. SAM will page the ICU or postanesthesia care unit nurse coordinator when a patient is in transport and print a transfer summary report to supplement a handoff checklist.

Another feature is barcode confirmation of syringe drugs, ensuring accuracy of medication administration in an area where incomplete or incorrect syringe labeling can be a significant problem, he said.

As an added safeguard, SAM also speaks the name of the medication when the clinician scans the barcode. However, it is also important to prevent “alert fatigue” for anesthesiologists and other hospital staff. That means carefully examining the data and behavioral patterns while listening closely to feedback from clinicians, Dr. Nair said.

New features and functions are still being added to SAM, with Dr. Nair and the UW exploring the possibility of licensing the module to AIMS vendors.

Under development is a preanesthetic induction patient safety checklist (PIPS), as part of a project initiated by T. Andrew Bowdle, MD, PhD, an anesthesiologist and professor at UW. Planned checklist items include whether suction is working; if backup devices are immediately available; or whether drug allergies or potential drug interactions have been noted, Dr. Nair said.

According to Dr. Nair, other future SAM enhancements will include:

• A framework for building checklists, as well as decision trees with navigation and guidance functions;
• Integration with UW’s electronic medical records system;
• Enhancing voice prompts, while expanding model- and protocol-based decision support;
• Integrating a fading memory algorithm for glucose management and a continuous glucose monitor; and
• Barcode verification of infusions and blood products to enhance medication and transfusion safety.