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April 25, 2019Anesthesia & Analgesia

Quality Improvement Interventions Associated With Improved Postoperative Nausea and Vomiting: Separating the Signal From the Noise

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Why the study?

Does an EMR-based clinical decision support approach reduce postoperative nausea and vomiting in surgical patients?

Design

Editorial

Authors

EMEdward J. MaschaTGTong J. GanTVThomas R. Vetter

Discussion

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Overview

Supports ERAS QI for PONV reduction; leaves open generalizability and causality without RCTs.

Structured PICO

Does an EMR-based clinical decision support approach reduce postoperative nausea and vomiting in surgical patients?

P
Population
Surgical patients assessed for postoperative nausea and vomiting risk
I
Intervention
Electronic medical record-based clinical decision support approach incorporating a new postoperative nausea and vomiting pathway, clinician education, and personalized feedback reporting
C
Comparator
Pre-intervention period (1 year prior)
O
Outcome
Incidence of postoperative nausea and vomiting (using administration of a rescue antiemetic in the postanesthesia care unit as a surrogate)surrogate

A multifaceted EMR-based clinical decision support intervention significantly reduced the incidence of postoperative nausea and vomiting, particularly among high-risk surgical patients.

Limitations

  • Use of rescue antiemetic in PACU as a surrogate may lead to inaccurate reporting
  • Observation limited to PACU likely underestimates true incidence within 24 hours
  • Unclear if antiemetic drug administered in PACU was specifically for PONV
  • Overlapping interventions make deciphering individual effects challenging

Cite This Study

Mascha et al. (2019) studied this question.

synapsesocial.com/papers/6a71a772a528af2d65c429bchttps://doi.org/10.1213/ane.0000000000004117
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Perioperative Quality Improvement: Opportunities and Challenges for Pragmatic Trial Designs2024
  2. 2Advancing Perioperative Medicine and Anesthesia Practices into the Era of Digital Quality Improvement2016 · 7 citations
  3. 3Quality improvement studies – pitfalls of the before and after study design2018 · 12 citations
  4. 4National Surgical Quality Improvement Program: What Can Anesthesiologists Learn From Surgical Outcomes?2018
  5. 5Continued Evolution of Perioperative Medicine: Realizing Its Full Potential2020 · 16 citations