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Advances in Non-Invasive Monitoring

Advances in Non-Invasive Monitoring

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Advances in Non-Invasive Monitoring

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  1. Advances in Non-Invasive Monitoring Michael O’Reilly, M.D., M.S. Chief Medical Officer Masimo Corporation Professor of Anesthesiology and Perioperative Care University of California-Irvine Adjunct Associate Professor University of Michigan

  2. Technology and Patient Safety Michael O’Reilly, M.D., M.S. Chief Medical Officer Masimo Corporation Professor of Anesthesiology and Perioperative Care University of California-Irvine Adjunct Associate Professor University of Michigan

  3. Technology Convergence Monitoring Information Communication

  4. Conflict of Interest Statement Masimo Corporation

  5. The influence of anesthesia care on surgical outcomes

  6. ACS-NSQIP (ACS=American College of Surgeons)

  7. 1 0 2 3 NSQIP Annual Report – FY 2000 Mortality O/E Ratios for All Operations

  8. But No Intraoperative Data! • No… • Estimated Blood Loss (EBL) • BP, HR, SPO2, Temperature • Duration of Surgery • Urine Output………Nothing. • But they have 30 Day Outcome. Surgery meets Anesthesiology

  9. European Surgical Outcomes Study (EuSOS) group for the Trials groups of the European Society of Intensive Care Medicine and the European Society of Anaesthesiology Lancet 2012; 380: 1059–65

  10. Methods: • 7 day cohort study • Consecutive patients aged ≥16 years • Inpatient non-cardiac surgery • 498 hospitals • 28 European nations • Patients followed up to 60 days • Primary endpoint in-hospital mortality • Secondary outcome LOS and ICU admission Lancet 2012; 380: 1059–65

  11. Results: • 46 539 patients • 1855 (4%) died before hospital discharge • 3599 (8%) patients were admitted to critical care • median LOS of 1・2 days (IQR 0・9–3・6) • 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. • Crude mortality rates between countries (from 1.2% for Iceland to 21.5% for Latvia) Lancet 2012; 380: 1059–65

  12. Note the Log Scale! Lancet 2012; 380: 1059–65

  13. Conclusion: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients. Lancet 2012; 380: 1059–65

  14. From the Michigan Surgical Collaborative for Outcomes Research and Evaluation, the Department of Surgery, University of Michigan, Ann Arbor. n engl j med 361:14; 2009

  15. METHODS • 84,730 patients • Inpatient general and vascular surgery • Data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) • Hospitals ranked according to risk-adjusted overall rate of death • Divided into five groups Each overall mortality quintile assessed the incidence of overall and major complications and the rate of death among patients with major complications. n engl j med 361:14; 2009

  16. n engl j med 361:14; 2009

  17. CONCLUSION “In addition to efforts aimed at avoiding complications in the first place, reducing mortality associated with inpatient surgery will require greater attention to the timely recognition and management of complications once they occur.” n engl j med 361:14; 2009

  18. Preventing “Failure to Rescue”

  19. Data Information Decisions Actions So we make the right decisions We have a lot of data! But what we really need is information! Leading to the right action.

  20. Information Sensors Data Light -SpO2 -SpHb -Cerebral oximetry -Tissue Oximetry Electrical -EKG -EEG -Impedance Acoustic Radar Ultrasound EHR Lab Pharmacy

  21. Sensors Data Information Decisions Actions Providers Different roles, different locations

  22. Technology Convergence Monitoring Information Communication

  23. Peter Pronovost, MD

  24. Preventing CLABSI !. Hand washing 2. Full barrier precautions 3. Clean the site with chlorhexidine 4. Avoid the femoral site 5. Remove unnecessary catheters

  25. “To really make progress, need cooperation of vendors, clinicians and administrators.”

  26. Implement known patient safety practices. Get vendors to provide open access to data.

  27. Technology Convergence Monitoring Information Communication

  28. Critical Care Medicine 2:317; 1974C

  29. Critical Care Medicine 2:317; 1974C

  30. Liver TransplantContinuous Noninvasive Hemoglobin

  31. A blood transfusion is an organ transplant.

  32. Variation of blood transfusion in patients undergoing major non-cardiac surgery Qian F. Et al. Ann Surg. 2013 Feb;257(2):266-78

  33. Blood Transfusion: Who is at risk The 1-3units of RBC transfused Goodnough L.T. Shander A. A&A 2012

  34. Remote Monitoring & Clinician Notification System

  35. Anesthesiology 112:284-9; 2010

  36. Transfers to ICU Comparison Unit 2 Comparison Unit 1 PSN 5.0 2.6 Anesthesiology 112:284-9; 2010

  37. Reduction in Rescue Calls PSN Comparison Unit 1 Comparison Unit 2 3.4 1.0 Taenzer, et al., Anesthesiology 112:284-9; 2010

  38. Significant Financial Implications Over a 12 month period decreased transfers to the ICU from 54 to 28 for one unit. With an average LOS of 6.3 days, translates into 163 ICU days saved