Automated electronic health record-based application for sedation triage in routine colonoscopy.

BACKGROUND AND AIMS: Nearly all routine endoscopy procedures are performed using moderate sedation (MS) or monitored anesthesia care (MAC). In this article, we describe how we improved decision-making and decreased practitioners' cognitive burden for choosing between MAC and MS by using patient data in an automated application within the electronic health record (EHR). METHODS: In our practice, we choose between MS or MAC for routine GI procedures according to written anesthesia-use guidelines and practitioner preferences. To expedite our decision-making for MS versus MAC, we developed an Excel (Microsoft Corp, Redmond, Wash, USA)-based tool from patient demographic characteristics, comorbid conditions, and medication use extracted from the EHR. The data points from Excel were then implemented in the automated application in the EHR to predict the type of sedation for GI procedures. RESULTS: Before use of the new application, nurses spent an average of 4 minutes and gastroenterology practitioners spent 5 minutes reviewing the EHR to determine the appropriate sedation (MS or MAC). After the application was implemented, the use of MS substantially increased. Time spent reviewing the EHR was reduced to 2 minutes. The rate of adverse events for MS (.5%) versus MAC (.6%) was comparable and low overall. CONCLUSIONS: The EHR-based application, which automates and standardizes determination of sedation type, is a highly beneficial tool that eliminates subjectivity in decision-making, thus allowing for appropriate use of MAC. Adverse event rates and sedation failure did not increase with use of the application. With the increased use of MS over MAC, healthcare costs for the more-expensive MAC sedation should also decrease.

Activating the Hospital Incident Command System Response in a Community Specialty Practice: The Mayo Clinic Experience.

INTRODUCTION: The COVID-19 pandemic presented health care organizations with a unique challenge in determining effective management of a large-scale incident across an extended time period. CASE PRESENTATION: This report describes the response of a multisite integrated system to the COVID-19 pandemic through activation of the Hospital Incident Command System. DISCUSSION: A robust emergency response plan with multidisciplinary involvement can help to ensure clear lines of accountability and expedite decision-making. Consistent physician input across affected specialties allows for a robust understanding of impacted areas, peer-to-peer communication, and a sense of ownership across the medical staff. The necessity of effective communication with staff and patients during times of crisis cannot be understated. The potential for information overload in a pandemic is significant but can be overcome through consistent and transparent communication from leadership. CONCLUSION: Health systems should have a well-organized emergency response system prepared to launch in small-scale or large-scale situations. The threshold to implement the response system and accountability to make that decision must be a clearly defined organizational policy.