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Implementation of an Epidural Rounding Reminder in the Electronic Medical Record Improves Performance of Standardized Patient Assessments during Labor.
Appl Clin Inform. 2023 03; 14(2):238-244.AC

Abstract

BACKGROUND

Poorly functioning labor epidural catheters lead to pain and dissatisfaction. Regular catheter assessment ensures timely identification of malfunction and may improve safety by facilitating rapid and successful conversion to general anesthesia for emergency cesarean. Informatics-based systems encourage standardization of care to identify epidural malfunctions earlier.

OBJECTIVES

This article demonstrates that visual epidural rounding reminder display on an electronic patient board would alert clinicians to elapsed time and decrease mean time between assessments.

METHODS

As a quality initiative, we implemented an epidural rounding reminder on our obstetric patient board. The reminder indicated the number of elapsed minutes since placement or last patient assessment. We retrospectively reviewed labor epidural charts 3 months prior to and 5 months following reminder implementation, with a 4-week washout period. The primary outcome was mean time between documented epidural assessments, with secondary outcomes including maximum time between assessments, total number of assessments during labor, catheter replacement rates, and patient satisfaction. Unadjusted comparisons between pre- and postimplementation groups were conducted using Wilcoxon's rank-sum and Pearson's chi-square tests, as appropriate. A test for equal variances was conducted for time between assessment outcomes.

RESULTS

Following implementation, mean time between assessments decreased from a median of 173 (interquartile range [IQR]: 53, 314) to 100 (IQR: 74, 125) minutes (p <0.001), and maximum time between assessments decreased from median 330 (IQR: 60, 542) to 162 (IQR: 125, 212) minutes (p < 0.001). Total number of evaluations during labor increased from 3 (IQR: 2, 4) to 5 (IQR: 3, 7; p < 0.001). Decreased variance in mean and maximum time between assessments was noted following reminder implementation (p < 0.001). Epidural replacement rates decreased from 14 to 5% postimplementation (p < 0.001). Patient satisfaction was unchanged.

CONCLUSION

Implementation of an informatics-based solution can promote standardization of care. A simple epidural rounding reminder prompted clinicians to perform more frequent labor epidural assessments. In the future, these process improvements must be linked to improvements in patient experiences and outcomes.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Ende HB
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
French B
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Shi Y
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Damron J
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Bauchat JR
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Dumas S
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Wanderer JP
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States. Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States.

MeSH

PregnancyFemaleHumansRetrospective StudiesElectronic Health RecordsAnalgesia, EpiduralLabor, ObstetricPain

Pub Type(s)

Journal Article

Language

eng

PubMed ID

36634697

Citation

Ende, Holly B., et al. "Implementation of an Epidural Rounding Reminder in the Electronic Medical Record Improves Performance of Standardized Patient Assessments During Labor." Applied Clinical Informatics, vol. 14, no. 2, 2023, pp. 238-244.
Ende HB, French B, Shi Y, et al. Implementation of an Epidural Rounding Reminder in the Electronic Medical Record Improves Performance of Standardized Patient Assessments during Labor. Appl Clin Inform. 2023;14(2):238-244.
Ende, H. B., French, B., Shi, Y., Damron, J., Bauchat, J. R., Dumas, S., & Wanderer, J. P. (2023). Implementation of an Epidural Rounding Reminder in the Electronic Medical Record Improves Performance of Standardized Patient Assessments during Labor. Applied Clinical Informatics, 14(2), 238-244. https://doi.org/10.1055/a-2011-8259
Ende HB, et al. Implementation of an Epidural Rounding Reminder in the Electronic Medical Record Improves Performance of Standardized Patient Assessments During Labor. Appl Clin Inform. 2023;14(2):238-244. PubMed PMID: 36634697.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Implementation of an Epidural Rounding Reminder in the Electronic Medical Record Improves Performance of Standardized Patient Assessments during Labor. AU - Ende,Holly B, AU - French,Benjamin, AU - Shi,Yaping, AU - Damron,James, AU - Bauchat,Jeanette R, AU - Dumas,Susan, AU - Wanderer,Jonathan P, Y1 - 2023/01/12/ PY - 2024/03/22/pmc-release PY - 2023/1/13/pubmed PY - 2023/3/25/medline PY - 2023/1/12/entrez SP - 238 EP - 244 JF - Applied clinical informatics JO - Appl Clin Inform VL - 14 IS - 2 N2 - BACKGROUND: Poorly functioning labor epidural catheters lead to pain and dissatisfaction. Regular catheter assessment ensures timely identification of malfunction and may improve safety by facilitating rapid and successful conversion to general anesthesia for emergency cesarean. Informatics-based systems encourage standardization of care to identify epidural malfunctions earlier. OBJECTIVES: This article demonstrates that visual epidural rounding reminder display on an electronic patient board would alert clinicians to elapsed time and decrease mean time between assessments. METHODS: As a quality initiative, we implemented an epidural rounding reminder on our obstetric patient board. The reminder indicated the number of elapsed minutes since placement or last patient assessment. We retrospectively reviewed labor epidural charts 3 months prior to and 5 months following reminder implementation, with a 4-week washout period. The primary outcome was mean time between documented epidural assessments, with secondary outcomes including maximum time between assessments, total number of assessments during labor, catheter replacement rates, and patient satisfaction. Unadjusted comparisons between pre- and postimplementation groups were conducted using Wilcoxon's rank-sum and Pearson's chi-square tests, as appropriate. A test for equal variances was conducted for time between assessment outcomes. RESULTS: Following implementation, mean time between assessments decreased from a median of 173 (interquartile range [IQR]: 53, 314) to 100 (IQR: 74, 125) minutes (p <0.001), and maximum time between assessments decreased from median 330 (IQR: 60, 542) to 162 (IQR: 125, 212) minutes (p < 0.001). Total number of evaluations during labor increased from 3 (IQR: 2, 4) to 5 (IQR: 3, 7; p < 0.001). Decreased variance in mean and maximum time between assessments was noted following reminder implementation (p < 0.001). Epidural replacement rates decreased from 14 to 5% postimplementation (p < 0.001). Patient satisfaction was unchanged. CONCLUSION: Implementation of an informatics-based solution can promote standardization of care. A simple epidural rounding reminder prompted clinicians to perform more frequent labor epidural assessments. In the future, these process improvements must be linked to improvements in patient experiences and outcomes. SN - 1869-0327 UR - https://www.unboundmedicine.com/medline/citation/36634697/Implementation_of_an_Epidural_Rounding_Reminder_in_the_Electronic_Medical_Record_Improves_Performance_of_Standardized_Patient_Assessments_during_Labor_ DB - PRIME DP - Unbound Medicine ER -