scholarly journals Is Mallampati Class More Consistent and Reliable among Providers When Assessed from Airway Photos?

2020 ◽  
Vol 2 (1) ◽  
pp. 1
Author(s):  
Joshua W. Sappenfield ◽  
Terrie Vasilopoulos ◽  
David Smyth ◽  
Nelson N. Algarra ◽  
F. Kayser Enneking ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Intraobserver Reliability ◽  
Chi Square ◽  
Anesthesia Providers ◽  
Mallampati Score ◽  
Observational Cohort ◽  
Digital Documentation ◽  
Low Sensitivity ◽  
Consistent Information

Accurate prediction of a difficult airway patient remains a challenge among laryngoscopists and anesthesia providers. Despite the lack of sensitivity and specificity of routine preoperative airway tests, many providers still perform them, suggesting they may still guide and influence airway planning. The most commonly used Mallampati exam has a low sensitivity. Our hypothesis was that digital documentation of the airway exam would improve intraobserver reliability between airway exams and provide more consistent information for airway providers. We obtained written informed consent from 250 patients presenting to the UF Health Shands Presurgical Center to participate in an observational cohort study. Their airway exam was photographed and uploaded into the electronic medical record. Data extracted from the electronic medical record were reviewed by three independent investigators. From chi-square analyses, there were significant differences (p < 0.05) in all measures across raters, indicating raters had varied assessments and predictions about patients. There were no statistically significant associations (p > 0.05) between Mallampati scores from the preassessment or reviews of photographs and the method of intubation or laryngoscopic view observed in the patient. There was also no statistically significant association between the Mallampati score and the use of video laryngoscopy for the intubation method. Moderate intraobserver reliability of the Mallampati exam may be a confounding factor regarding the lack of a significant relationship between the Mallampati exam and the assessment of whether a patient may be difficult to intubate, or the method chosen to facilitate intubation in this study.

scholarly journals Information needs for the OR and PACU electronic medical record

2014 ◽  
Vol 05 (03) ◽  
pp. 630-641 ◽  
Author(s):  
V. Herasevich ◽  
J.R. Hebl ◽  
M.J. Brown ◽  
B.W. Pickering ◽  
M.A. Ellsworth
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Medical Error ◽  
Information Needs ◽  
Clinical Decision Making ◽  
Information Overload ◽  
Clinical Information ◽  
Clinical Decision ◽  
Anesthesia Providers ◽  
Survey Responses

Summary Objective: The amount of clinical information that anesthesia providers encounter creates an environment for information overload and medical error. In an effort to create more efficient OR and PACU EMR viewer platforms, we aimed to better understand the intraoperative and post-anesthesia clinical information needs among anesthesia providers. Materials and Methods: A web-based survey to evaluate 75 clinical data items was created and distributed to all anesthesia providers at our institution. Participants were asked to rate the importance of each data item in helping them make routine clinical decisions in the OR and PACU settings. Results: There were 107 survey responses with distribution throughout all clinical roles. 84% of the data items fell within the top 2 proportional quarters in the OR setting compared to only 65% in the PACU. Thirty of the 75 items (40%) received an absolutely necessary rating by more than half of the respondents for the OR setting as opposed to only 19 of the 75 items (25%) in the PACU. Only 1 item was rated by more than 20% of respondents as not needed in the OR compared to 20 data items (27%) in the PACU. Conclusion: Anesthesia providers demonstrate a larger need for EMR data to help guide clinical decision making in the OR as compared to the PACU. When creating EMR platforms for these settings it is important to understand and include data items providers deem the most clinically useful. Minimizing the less relevant data items helps prevent information overload and reduces the risk for medical error. Citation: Herasevich V, Ellsworth MA, Hebl JR, Brown MJ, Pickering BW. Information needs for the OR and PACU electronic medical record. Appl Clin Inf 2014; 5: 630–641http://dx.doi.org/10.4338/ACI-2014-02-RA-0015

scholarly journals 176. Impact of pharmacist electronic communication on the appropriateness of antimicrobial therapy at renewal time

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S95-S95
Author(s):  
Ahmad Taqi ◽  
Salwa Elarabi ◽  
Jorge Fleisher
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Best Practice ◽  
Primary Outcome ◽  
Intervention Group ◽  
Antibiotic Use ◽  
Categorical Variables ◽  
Chi Square ◽  
Days Of Therapy ◽  
Chi Square Test

Abstract Background Inappropriate antibiotic use increases the risk of antimicrobial resistance and adverse events. Our institution adopts all elements recommended by the CDC to improve antimicrobial stewardship (AMS). Compliance with such elements requires education, coaching and decision support tools. The objective of the study intervention is to engage prescribers to critically evaluate and improve antibiotic utilization through renewal communication in the electronic medical record (EMR). Methods This is a single center study with a retrospective phase and prospective phase. During the intervention period from October 1st, 2019 to January 1st, 2020 the pharmacist monitored targeted antibiotics and initiated an AMS EMR note. Prescribers were then requested to evaluate the appropriateness of therapy utilizing pre-defined criteria developed in agreement with the infectious disease (ID) service at 48 hours, in-line with the EMR time-out alert. Adults receiving vancomycin (VAN), piperacillin/tazobactam (TAZ), cefepime (CEF) or meropenem (MPN) for at least 48 hours were included. The historical group included patients on the targeted antibiotics between July 1st, 2019 and September 30th, 2019. The primary outcome was median days of therapy (DOT). Secondary outcomes were median DOT per antibiotic, percentage of ID consults and percentage of antibiotic optimization. Statistical analyses were conducted using T-test and chi-square test for continuous and categorical variables respectively. Results A total of 81 and 72 patients were included in the intervention and historical groups respectively. No statistical difference in the primary outcome of median DOT was observed (4.5 vs 4, p=0.5). However, Non-significant numerical reductions in DOT were observed for VAN (3 vs 3.5, p=0.5), CEF (3 vs 4, p=0.6) and TAZ (3 vs 4, p=0.3), but not for MPN (6 vs 5, p=0.6). The intervention resulted in more ID consults when prescribing targeted antibiotics (59.3% vs 41.6%, p=0.03). In the intervention group, antibiotic treatment was optimized in 87.7% of patient, in which 39.6% were treatment de-escalation and discontinuation. Conclusion Pharmacist clinical guidance through the electronic medical record can provide a powerful educational tool to promote adherence to antimicrobials best practice Disclosures All Authors: No reported disclosures

Virtuelle Medizin in der Behandlung von Sucht in den USA, Kanada und darüber hinaus

Suchttherapie ◽  
2020 ◽  
Vol 21 (04) ◽  
pp. 189-193
Author(s):  
R. Michael Krausz ◽  
Farhud Shams ◽  
Maurice Cabanis
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Electronic Medical Record Systems

ZusammenfassungInsbesondere während der aktuellen Corona-Pandemie hat der Gebrauch virtueller Lösungen in der Medizin international stark zugenommen. Es gibt eine zunehmende Akzeptanz gerade auch in dem Bereich der hausärztlichen Versorgung, der Behandlung psychischer Störungen und der Abhängigkeitserkrankungen.Die Entwicklung ist international unterschiedlich, v. a, wenn man die USA und Kanada auf der einen Seite und Europa, insbesondere Deutschland, andererseits vergleicht. In Nordamerika hat bei dem Einsatz von moderner Technologie die Einführung von „Electronic Medical Record Systems“ eine dominierende Rolle gespielt. Diese ist insbesondere auf Abrechnung und Dokumentation zu Versicherungszwecken fokussiert. Daneben gibt es zunehmend Apps, die spezifische therapeutische Ansätze zu implementieren helfen. Die Anwendung virtueller Ansätze im Suchtbereich ist begrenzt, aber in Teilen sehr innovativ und auf deutsche Verhältnisse anwendbar. Wie in Europa gibt es auch in Nordamerika nur sehr begrenzte Forschungskapazitäten und prinzipiell Widerstand bei den medizinischen Berufsgruppen bezüglich der Anwendungsmöglichkeiten und der Rolle im Behandlungsprozess. Mehr Kooperation würde international zu einer Beschleunigung der Entwicklung und der Etablierung gemeinsamer Standards beitragen sowie die Behandlungssysteme bedeutend verbessern.

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