Development and Feasibility of a Real-Time Clinical Decision Support System for Traumatic Brain Injury Anesthesia Care.

Abstract

Real-time clinical decision support (CDS) integrated with anesthesia information management systems (AIMS) can generate point of care reminders to improve quality of care. To develop, implement and evaluate a real-time clinical decision support system for anesthetic management of pediatric traumatic brain injury (TBI) patients undergoing urgent neurosurgery. We iteratively developed a CDS system for pediatric TBI patients undergoing urgent neurosurgery. The system automatically detects eligible cases and evidence-based key performance indicators (KPIs). Unwanted clinical events trigger and display real-time messages on the AIMS computer screen. Main outcomes were feasibility of detecting eligible cases and KPIs, and user acceptance. The CDS system was triggered in 22 out of 28 (79%) patients. The sensitivity of detecting continuously sampled KPIs reached 93.8%. For intermittently sampled KPIs, sensitivity and specificity reached 90.9% and 100%, respectively. 88% of providers reported that CDS helped with TBI anesthesia care. CDS implementation is feasible and acceptable with a high rate of case capture and appropriate generation of alert and guidance messages for TBI anesthesia care.