Key result
EHR clinical decision support reduces sevoflurane fresh gas flow by ~0.6 L/min, curbing volatile agent waste.
Why the study?
It was unknown whether decision support tools embedded within commercial electronic health record systems could be successfully adopted to achieve long-term reductions in fresh gas flow rates.
Does a commercial electronic health record clinical decision support tool reduce fresh gas flow rates and volatile anesthetic consumption during the maintenance phase of general anesthesia?
Cohort (n=90,467)
Open-label
No
Does a commercial electronic health record clinical decision support tool reduce fresh gas flow rates and volatile anesthetic consumption during the maintenance phase of general anesthesia?
Implementing a rule-based clinical decision support alert natively within a commercial electronic health record system achieved sustained reductions in fresh gas flow and volatile anesthetic waste, saving an estimated $123,120 annually.
Answers are grounded in this paper and cite their sources.
Supports EHR alerts to cut volatile waste; leaves open generalizability and need for randomized confirmation before practice change.
BACKGROUND: Volatile anesthetic consumption can be reduced by minimizing excessive fresh gas flows (FGFs). Currently, it is unknown whether decision support tools embedded within commercial electronic health record systems can be successfully adopted to achieve long-term reductions in FGF rates. The authors describe the implementation of an electronic health record-based clinical decision support tool aimed at reducing FGF and evaluate the effectiveness of this intervention in achieving sustained reductions in FGF rates and volatile anesthetic consumption. METHODS: On August 29, 2018, we implemented a decision support tool within the Epic Anesthesia Information Management System (AIMS) to alert providers of high FGF (>0.7 L/min for desflurane and >1 L/min for sevoflurane) during maintenance of anesthesia. July 22, 2015, to July 10, 2018, served as our baseline period before the intervention. The intervention period spanned from August 29, 2018, to December 31, 2019. Our primary outcomes were mean FGF (L/min) and volatile agent consumption (mL/MAC-h). Because a simple comparison of 2 time periods may result in false conclusions due to underlying trends independent of the intervention, we performed segmented regression of the interrupted time series to assess the change in level at the start of the intervention and the differences in slopes before and after the intervention. The analysis was also adjusted for potential confounding variables. Data included 44,899 cases using sevoflurane preintervention with 26,911 cases postintervention, and 17,472 cases using desflurane with 1185 cases postintervention. RESULTS: Segmented regression of the interrupted times series demonstrated a decrease in mean FGF by 0.6 L/min (95% CI, 0.6-0.6 L/min; P < .0001) for sevoflurane and 0.2 L/min (95% CI, 0.2-0.3 L/min; P < .0001) for desflurane immediately after implementation of the intervention. For sevoflurane, mL/MAC-h decreased by 3.8 mL/MAC-h (95% CI, 3.6-4.1 mL/MAC-h; P < .0001) after implementation of the intervention and decreased by 4.1 mL/MAC-h (95% CI, 2.6-5.6 mL/MAC-h; P < .0001) for desflurane. Slopes for both FGF and mL/MAC-h in the postintervention period were statistically less negative than the preintervention slopes (P < .0001 for sevoflurane and P < .01 for desflurane). CONCLUSIONS: A commercial AIMS-based decision support tool can be adopted to change provider FGF management patterns and reduce volatile anesthetic consumption in a sustainable fashion.
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Olmos et al. (2022) conducted a cohort in General anesthesia using volatile anesthetic agents (sevoflurane or desflurane) (n=90,467). Electronic health record clinical decision support tool (Epic AIMS Best Practice Advisory alerting for fresh gas flow >1 L/min for sevoflurane and >0.7 L/min for desflurane) vs. Pre-intervention baseline period prior to clinical decision support activation (July 22, 2015 to July 10, 2018) was evaluated on Mean fresh gas flow (FGF, L/min) and volatile agent consumption (mL per minimum alveolar concentration-hour [mL/MAC-h]) for sevoflurane (MD -0.6 L/min for sevoflurane FGF; MD -3.8 mL/MAC-h for sevoflurane consumption, 95% CI 0.6-0.6, p=<0.0001). An EHR clinical decision support tool reduced mean fresh gas flow by 0.6 L/min (P < 0.0001) for sevoflurane and 0.2 L/min (P < 0.0001) for desflurane, significantly lowering volatile agent waste.
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