Effect of automatic record keeping on vigilance and record keeping time.

We have evaluated the effect of an automatic anaesthesia record keeper (AARK) on record keeping time and vigilance. With informed patient consent and institutional approval, we videotaped the attending anaesthetist and his/her immediate surroundings during 66 surgical procedures. Thirty-seven cases were charted manually and the remaining 29 were charted with a commercially available AARK. In order to evaluate vigilance, a physician examiner entered the operating room unannounced once during 33 of the manually charted cases and during 22 of the automatically charted cases and asked the anaesthetist to turn away from the monitors and recall the current value of eight patient physiological variables. The examiner recorded the recalled values and also the actual current monitor values of these variables. The videotapes were reviewed and the anaesthetist's intraoperative time was categorized into 15 predefined activities, including intraoperative anaesthesia record keeping time. We compared recalled and actual variable values to determine if the recalled values were within clinically relevant error limits. There was no statistical difference between the mean percentage case time spent recording manually (14.11 (SD 3.98)%) and automatically (12.39 (3.92)%). Moreover, use of the AARK did not significantly affect vigilance. Despite major advances in monitoring technology over the past 14 years, record keeping still occupies 10-15% of the anaesthetist's intraoperative time. It appears that in using an AARK, the anaesthetist reallocates intraoperative record keeping time from manual charting to dealing with problems in the anaesthetist machine interface caused by inadequate design.

Clinical evaluation of the 'head-up' display of anesthesia data. Preliminary communication.

To solve the problem of monitoring the patient during administration of anesthesia, a commercially available head-up display (HUD) was evaluated during one day of surgery at the Ohio State University Hospitals. This monitor is mounted on a headband worn by the anesthesiologist. It projects a monochrome image of monitor data directly into one eye. Eleven anesthesiologists tested the device. Most users were able to adjust to the monitor in about fifteen minutes. Nine of the testers expressed a desire to evaluate the monitor further. Their major complaints were that the connecting cable between the HUD and its computer was too short, the resolution of the monitor was inadequate, and the data on the screen were not organized in a familiar way. If these problems could be corrected, most users believed that this HUD could be a valuable tool to aid the anesthesiologist in the operating room.