The efficiency of anesthesiologists in the OR is always something that hospitals are looking into.
In response to this need, researchers at Vanderbilt University recently reported the creation and successful implementation of a medical app that can be used to increase their situational awareness of patients.
Their implementation of the app focused on its use by anesthesiologists, but the app could be replicated in concept to meet the needs of other health professionals.
Situational awareness is a concept from the airline industry which is used to enhance airline safety.
According to the researchers, the concept promotes adherence to three core principles:
In the context of anesthesiology, situational awareness means that they are being made aware of events that are taking place with patients, and how information and actions impact the objectives for patients in the perioperative environment. Anesthesiologists were of interest to the researchers because they currently utilized stationary workstations to manage patients.
However, the stationary approach does not match their actual work flow, which requires them to move between different operating rooms and supervise multiple staff members in a seamless fashion. One particular problem that anesthesiologists face is knowing which room to go to next when managing multiple nurse anesthetists who are working with patients.
They need to be able to quickly review the status of patients in different rooms in order to decide where they are most needed at any given time. The researchers thought a mobile device and related app were well suited for such a challenge.
Explanation of the App
The VigiVU™ app was created using the iOS platform. Researchers indicate that the app took approximately 1,000 development hours. The app offers real time access to the operating room which allows anesthesiologists to assess the existing situation of their staff.
Features include real time operating room video, patient vital signs, anesthetic interventions, OR management visualization tools, patient data protection, bidirectional voice and text communication, and integrated electronic medical record access.
Currently, anesthesiologists can find out the status of up to four patients in different locations simultaneously with this app. It also allows anesthesiologists to prioritize patients and follow their progress throughout the OR. The app offers a consistent user view on different devices allowing users to see similar information on any device using the iOS system. While this integration is extremely useful, it still isolates those with other devices.
The app can be customized to provide alerts called “push notifications” to anesthesiologists. Each anesthesiologists chooses the appropriate alerts that she/he desires. In this manner, the app can provide unique information to each anesthesiologists.
The researchers indicate that VigiVU is specific to Vanderbilt’s perioperative information management system (which provided situational awareness information about patients), but the app’s code and concepts can be applied to “any health care environment inside or outside the perioperative space” as long as electronic health care data is available in real time for app developers to use via standard interfaces.
Implementation of the App
The researchers began with five pilot testers of their first version of the app. This grew to more pilot testers over time. In total, the researchers piloted the app on a group of 40 individuals and discovered that they all used the app consistently and did not get rid of their copy of the app. The researchers interepreted this as acceptance by the users. The researchers initially designed the app for anesthesiologists, but stated that its appeal has led to requests by other perioperative staff (i.e. surgeons) to request access to the app.
The researchers also compared the speed of information being sent to the VigiVU iPhone app to pagers being used by Vanderbilt and found that the iPhone received the same messages faster than pagers. In addition, they assessed the impact of VigiVU on battery life. The use of the app during an 11 hour work day led to 26% of the battery life remaining with a standard deviation of 5.85% and n=10.
The researchers point out that the app’s acceptance is linked to other institutional factors. For example, a culture of existing situational awareness information gathering appeared to contribute to the initial acceptance of the app. The researchers indicate that acceptance of video cameras is extremely high in the Vanderbilt University Medical Center due to ongoing education of staff and patients about the use of the cameras.
The researchers pointed out a number of limitations to the app including its platform (iOS only), potential cell phone signal problems in hospitals, documentation habits of the in-room provider which affect how fast information that is not monitored electronically reaches the anesthesiologist.
Next Research Steps
The impact of VigiVU on clinical care remains to be seen. The researchers have laid the groundwork for a potentially significant app which may increase the efficiency of an anesthesiologist’s work flow. They indicate that future research will focus on how the app enhances patient safety and/or operating room efficiency. The customizable feature of the app, while useful, might pose problems for comparing the impact of the app on different doctors because the app is being tweaked to provide more or less notifications. A consistent approach for the push notifications in a particular field of anesthesiology may be necessary for designing studies that assess the effects of the app on patient outcomes and operating room efficiency.
As stated, the app is limited to Vanderbilt, so even with positive research findings in the future, replicating VigiVU’s unique approach will take substantial infrastructure changes for medical centers that lack the extensive situational awareness information management system that Vanderbilt has. However, Vanderbilt may be on their way to a potential best practice for the field which, with adequate evidential support in the future, may have a substantial impact on patient care and the field of anesthesiology.
Of interest to developers/innovators
The customized nature of this app to Vanderbilt’s information management system should garner the attention of developer’s working in this space. Given the unique array of monitoring systems that hospitals use, a number of hospitals who are interested in such an app may need customized solutions rather than an off the shelf product.