The Impact of an Intraoperative Clinical Decision Support Tool to Optimize Perioperative Glycemic Management.
The Impact of an Intraoperative Clinical Decision Support Tool to Optimize Perioperative Glycemic Management.
复制标题
DOI：
10.1007/s10916-020-01643-1
复制
发表时间：
2020-08-21
影响因子：
5.3
通讯作者：
Wanderer JP
中科院分区：
文献类型：
--
作者：
Li G;Dietz CJK;Freundlich RE;Shotwell MS;Wanderer JP
随着从范德比尔特的围手术期信息管理系统（VPIMS）过渡到Epic的最佳实践咨询（BPA）框架，设计了一种替代术中血糖临床决策支持（CDS）系统。我们检查了麻醉后监护室（PACU）术中血糖监测频率、高血糖和低血糖发生率的变化，以确定这些变化对血糖管理的影响。数据收集分为三个阶段：1）VPIMS CDS，2）无CDS和3）BPA CDS。进行单因素方差分析来检验各阶段血糖监测频率和异常血糖变化的显著性。进行中断时间序列分段分析以评估随时间的自相关性和趋势。共分析了3706例病例。监测率从VPIMS CDS的84.5%降至无CDS的67.6%（p < .001），BPA CDS的监测率增至83.1%（p < .001）。PACU高血糖率从VPIMS CDS增加到无CDS（5.2%至10.4%，p <0.001），从无CDS减少到BPA CDS（10.4%至7.2%，p = 0.031）。分段分析表明，更换CDS后，术中监测频率（p<0.001）和术后高血糖发生率（p = 0.002）立即发生变化。暂时移除CDS与术中血糖监测显著减少和PACU中高血糖增加相关。BPA CDS的实施显著改善了PACU的术中血糖监测和血糖管理。
With the transition from Vanderbilt’s Perioperative Information Management System (VPIMS) to Epic’s Best Practice Advisory (BPA) framework, a replacement intraoperative glucose clinical decision support (CDS) system was designed. We examined changes in the frequency of intraoperative glucose monitoring, hyper- and hypoglycemia rates in the post-anesthesia care unit (PACU), to determine the impact of the changes on glucose management. Data were collected into three phases: 1) VPIMS CDS, 2) No CDS, and 3) BPA CDS. One-way ANOVA was conducted to test the significance of changes in the frequency of glucose monitoring and abnormal glucose across phases. Interrupted time series segmented analysis was performed to assess the autocorrelation and trend over times. A total of 3706 cases were analyzed. The monitoring rate fell from 84.5% in VPIMS CDS to 67.6% in No CDS (p < .001) and increased to 83.1% in BPA CDS (p < .001). The PACU hyperglycemia rate increased from VPIMS CDS to No CDS (5.2% to 10.4%, p < .001) and decreased from No CDS to BPA CDS (10.4% to 7.2%, p = 0.031). The segmented analysis demonstrated immediate changes in the intraoperative monitoring frequency (p< .001) and postoperative hyperglycemia rate (p = 0.002) with the replacement of CDS. The temporary removal of CDS was associated with a significant reduction in intraoperative glucose monitoring and increased hyperglycemia in the PACU. Implementation of the BPA CDS led to a significant improvement in the intraoperative glucose monitoring and glucose management in the PACU.
登录
查看更多内容
影响因子：
5.7
作者：
O'Reilly, Michael;Talsma, AkkeNeel;Burney, Richard
通讯作者：
Burney, Richard
影响因子：
2.2
作者：
Nair, Bala G.;Grunzweig, Katherine;Dellinger, E. Patchen
通讯作者：
Dellinger, E. Patchen
影响因子：
8.8
作者：
Sandberg, WS;Daily, B;Rattner, D
通讯作者：
Rattner, D
影响因子：
3.8
作者：
Stahl, JE;Egan, MT;Rattner, DW
通讯作者：
Rattner, DW
影响因子：
7.7
作者：
Bernal JL;Cummins S;Gasparrini A
通讯作者：
Gasparrini A