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Electronic Obstetric Anesthesia Documentation for Better or Worse - Review of Epic Implementation at the Brigham and Women’s Hospital
Abstract Number: F-08
Abstract Type: Original Research
Background: Electronic health record (EHR) systems have been shown to enhance patient safety. The obstetrical anesthesia group at Brigham and Women’s Hospital has adopted Epic electronic anesthesia record system on May 30, 2015. The purpose of this study is to evaluate the implementation and transition of the electronic anesthesia record system.
Methods: We randomly selected 80 obstetric anesthesia records for review, including 40 labor deliveries and 40 cesarean delivery cases, among which half of the cases were from the 1st month of Epic implementation and the other half were from the 7th month of implementation, respectively. All the records were reviewed based on four different data entry categories: Patient Demographic Data, Pre-Anesthetic Evaluation, Anesthesia Management Data, and Patient Follow-Up Data. Missing data points and errors were recorded. Fisher’s exact test was used for data analysis.
Results: There was a trend of reduction for patients’ demographic. (Table 1) Significant improvements were seen in three categories: patient follow-up in labor analgesia, pre-anesthetic evaluation for cesarean delivery and anesthesia management for cesarean delivery. (Table 2)
Discussion: Obstetric module is a relatively new component within the Epic system. Our study indicates that the Epic system does carry numbers of correctable flaws that requires constant system level maintenance and update of software. However, the fact of the slow reduction of missing or erroneous data points in patient demographic data partially implies shortage of informatics support. The comparison of the difference in the reduction of missing data in pre-anesthetic evaluations between labor analgesia and cesarean delivery patients could be attributed to the differences in the settings and mechanisms of how patients were evaluated. These data implies that the pre-anesthetics evaluations for labor analgesia, which were often performed by residents, were not as thorough as those of for cesarean deliveries. Closer fellow or attending supervision is indicated. The improvement of patient follow-up for labor analgesia patients indicates that anesthesiologists were better trained in using the electronic follow-up tool over the period. On the contrary, the persistent missing data in the follow-up for cesarean deliveries suggested potential system level problems might exist.
1. Peterfreund RA, et al. 2011.
2. Riley JB, et al. 2015.
3. Steffens TG, et al. 2015.