An Intraoperative Telemedicine Program to Improve Perioperative Quality Measures: The ACTFAST-3 Randomized Clinical Trial.
An Intraoperative Telemedicine Program to Improve Perioperative Quality Measures: The ACTFAST-3 Randomized Clinical Trial.
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DOI：
10.1001/jamanetworkopen.2023.32517
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发表时间：
2023-09-05
影响因子：
13.8
通讯作者：
ACTFAST Study Grp
中科院分区：
文献类型：
--
作者：
King, Christopher R.;Gregory, Stephen;Fritz, Bradley A.;Budelier, Thaddeus P.;Ben Abdallah, Arbi;Kronzer, Alex;Helsten, Daniel L.;Torres, Brian;Mckinnon, Sherry;Goswami, Shreya;Mehta, Divya;Higo, Omokhaye;Kerby, Paul;Henrichs, Bernadette;Wildes, Troy S.;Politi, Mary C.;Abraham, Joanna;Avidan, Michael S.;Kannampallil, Thomas;ACTFAST Study Grp
实时术中远程医疗项目能提高围手术期护理措施的质量吗？在这项随机临床试验中，26254名患者在一个学术医疗中心接受手术，术中远程医疗决策支持干预并没有显著降低术后低体温或高血糖，也没有显著改善大多数围手术期护理措施的质量。然而，糖尿病患者术中血糖测量在干预中更为常见。这些发现表明，进一步简化临床决策支持和工作流程可能有助于术中远程医疗项目在有针对性的临床措施方面取得改善。远程医疗用于临床决策支持已被许多卫生保健机构采用，但其在改善术中护理方面的效用尚未得到评估。试点实施实时术中远程医疗决策支持计划，并评估其是否能降低术后低体温和高血糖以及其他护理措施的质量。这项单中心试点随机临床试验（麻醉控制塔-补充治疗反馈警报[ACTFAST-3]）于2017年4月3日至2019年6月30日在美国一家大型学术医疗中心进行。共26 254例成人手术患者随机分为两组，一组接受常规术中护理（对照组，n = 12 980），另一组接受常规护理并辅以远程医疗决策支持（干预组，n = 13 274）。数据最初分析于2021年4月22日至5月19日，并于2022年11月和2023年2月更新。患者接受常规护理（麻醉护理小组的医疗指导）或术中麻醉护理，由麻醉控制塔（ACT）实时远程医疗干预的决策支持进行监测和增强。ACT由一组麻醉临床医生使用定制的分析软件对手术室进行远程监控。ACT审查警报和电子健康记录数据，为手术室临床医生提供建议。主要结局是避免术后低体温（定义为术中最终记录核心温度> - 36°C的患者比例）和高血糖（定义为到达麻醉后恢复区血糖水平≤180 mg/dL的糖尿病患者比例）。次要结局包括术中低血压、体温监测、及时给药、术中血糖评估和管理、神经肌肉阻滞记录、呼吸机管理和挥发性麻醉剂过度使用。在26 254名参与者中，女性13 393人（51.0%），白人20 169人（76.8%），中位（IQR）年龄为60（47-69）岁。在避免高血糖（干预组8676例患者中7445例[85.8%]vs对照组8815例患者中7559例[85.8%]）或低体温（干预组11447例患者中7602例[66.4%]vs 11672例患者7783例[66.7]）方面均无治疗效果。%]为对照组；RR 1.00;95% ci, 0.97-1.02)。干预组糖尿病患者术中血糖测量更为常见（RR, 1.07; 95% CI, 1.01-1.15），但其他次要结局无显著差异。在这项随机临床试验中，麻醉护理质量测量在两组之间没有差异，研究结果具有很高的可信度。这些结果表明，干预不影响目标护理实践。进一步简化临床决策支持和工作流程可能有助于术中远程医疗项目在有针对性的临床措施方面取得改善。本随机临床试验评估了在美国实施实时术中远程医疗决策支持程序是否能降低成年外科患者术后低体温和高血糖以及其他麻醉护理质量措施。
Does a real-time intraoperative telemedicine program improve perioperative quality of care measures? In this randomized clinical trial of 26 254 patients having surgery at a single academic medical center, an intraoperative telemedicine decision support intervention did not significantly reduce postoperative hypothermia or hyperglycemia and did not significantly improve most perioperative quality of care measures. However, intraoperative glucose measurement in patients with diabetes was more common with the intervention. These findings suggest that further streamlining of clinical decision support and workflows may help the intraoperative telemedicine program achieve improvement in targeted clinical measures. Telemedicine for clinical decision support has been adopted in many health care settings, but its utility in improving intraoperative care has not been assessed. To pilot the implementation of a real-time intraoperative telemedicine decision support program and evaluate whether it reduces postoperative hypothermia and hyperglycemia as well as other quality of care measures. This single-center pilot randomized clinical trial (Anesthesiology Control Tower–Feedback Alerts to Supplement Treatments [ACTFAST-3]) was conducted from April 3, 2017, to June 30, 2019, at a large academic medical center in the US. A total of 26 254 adult surgical patients were randomized to receive either usual intraoperative care (control group; n = 12 980) or usual care augmented by telemedicine decision support (intervention group; n = 13 274). Data were initially analyzed from April 22 to May 19, 2021, with updates in November 2022 and February 2023. Patients received either usual care (medical direction from the anesthesia care team) or intraoperative anesthesia care monitored and augmented by decision support from the Anesthesiology Control Tower (ACT), a real-time, live telemedicine intervention. The ACT incorporated remote monitoring of operating rooms by a team of anesthesia clinicians with customized analysis software. The ACT reviewed alerts and electronic health record data to inform recommendations to operating room clinicians. The primary outcomes were avoidance of postoperative hypothermia (defined as the proportion of patients with a final recorded intraoperative core temperature >36 °C) and hyperglycemia (defined as the proportion of patients with diabetes who had a blood glucose level ≤180 mg/dL on arrival to the postanesthesia recovery area). Secondary outcomes included intraoperative hypotension, temperature monitoring, timely antibiotic redosing, intraoperative glucose evaluation and management, neuromuscular blockade documentation, ventilator management, and volatile anesthetic overuse. Among 26 254 participants, 13 393 (51.0%) were female and 20 169 (76.8%) were White, with a median (IQR) age of 60 (47-69) years. There was no treatment effect on avoidance of hyperglycemia (7445 of 8676 patients [85.8%] in the intervention group vs 7559 of 8815 [85.8%] in the control group; rate ratio [RR], 1.00; 95% CI, 0.99-1.01) or hypothermia (7602 of 11 447 patients [66.4%] in the intervention group vs 7783 of 11 672 [66.7.%] in the control group; RR, 1.00; 95% CI, 0.97-1.02). Intraoperative glucose measurement was more common among patients with diabetes in the intervention group (RR, 1.07; 95% CI, 1.01-1.15), but other secondary outcomes were not significantly different. In this randomized clinical trial, anesthesia care quality measures did not differ between groups, with high confidence in the findings. These results suggest that the intervention did not affect the targeted care practices. Further streamlining of clinical decision support and workflows may help the intraoperative telemedicine program achieve improvement in targeted clinical measures. ClinicalTrials.gov Identifier: NCT02830126 This randomized clinical trial evaluates whether implementation of a real-time intraoperative telemedicine decision support program reduces postoperative hypothermia and hyperglycemia as well as other anesthesia care quality measures among adult surgical patients in the US.
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影响因子：
3.7
作者：
Backman R;Bayliss S;Moore D;Litchfield I
通讯作者：
Litchfield I
DOI：
10.1093/jamia/ocac138
发表时间：
2022-08-19
影响因子：
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作者：
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通讯作者：
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作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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DOI：
10.1093/jamia/ocaa140
发表时间：
2020-12-01
影响因子：
6.4
作者：
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通讯作者：
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