Key result
Electronic data abstraction captured more patients but identified a lower 24-hour post-operative nausea and vomiting rate (15%) compared to manual audit (20%), likely due to less enrolment bias.
Why the study?
Manual audit of adherence to PONV prevention guidelines is resource intensive, while electronic audit can require costly anaesthetic and medical records.
Does electronic data abstraction compared to manual chart extraction improve patient capture and alter reported rates for routine post-operative nausea and vomiting audit in surgical inpatients?
Observational (n=3,510)
No
Does electronic data abstraction compared to manual chart extraction improve patient capture and alter reported rates for routine post-operative nausea and vomiting audit in surgical inpatients?
Absolute Event Rate: 15% vs 20%
Electronic data abstraction for PONV audit captures more patients and yields lower reported PONV rates compared to manual audit, likely due to reduced enrollment bias.
Electronic audits may improve PONV capture; leaves open whether lower rates reflect bias or true incidence, warranting prospective validation.
BACKGROUND: Post-operative nausea and vomiting (PONV) is a common cause of patient dissatisfaction following anaesthesia. Audit of adherence to PONV prevention guidelines is resource intensive when performed by manual chart extraction. Electronic audit can require costly anaesthetic and medical records. OBJECTIVE: In our single-site study we sought to compare manual and electronic PONV audits by utilizing existing non-anaesthetic electronic medical records to avoid expensive additional software. METHODS: The audits were performed from 13 January 2020 to 1 February 2020 for surgical inpatients. Two PONV periods were captured-the post-anaesthetic recovery unit and on the ward (to 24 h). Electronic PONV was defined as the administration of an anti-emetic medication. A 6-month electronic PONV rate was also calculated. RESULTS: Manual audit captured 142 patients and electronic audit captured 294 patients, over the same time period. The manual PONV rate was 10% (95% confidence interval (CI) 5-16%) in the post-anaesthetic recovery unit and 20% (95% CI 14-28%) the next day. The electronic rate was 5% (95% CI 3-8%) in the post-anaesthetic recovery unit and 15% (11-19%) in a 24-h period. The 6-month electronic audit found 3510 patients, with a post-anaesthetic recovery unit and 24-h PONV rates of 5% (4-6%) and 14% (13-16%), respectively. Electronic audit did not identify 5.8% of PONV patients in the manual audit. CONCLUSION: Electronic audit enrolled more patients and identified a lower PONV rate than manual audit, likely from less enrolment bias. Electronic audit was easily repeated over a 6-month period. While electronic PONV audit is possible without additional software, an electronic anaesthetic chart would greatly improve audit quality.
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Miller et al. (2021) conducted an observational in Post-operative nausea and vomiting (PONV) (n=3,510). Electronic data abstraction vs. Manual chart extraction was evaluated on 24-hour post-operative nausea and vomiting rate. Electronic data abstraction captured more patients but identified a lower 24-hour post-operative nausea and vomiting rate (15%) compared to manual audit (20%), likely due to less enrolment bias.
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