advances in non-invasive monitoring
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Advances in Non-Invasive Monitoring. Michael O’Reilly, M.D., M.S. Chief Medical Officer Masimo Corporation Professor of Anesthesiology and Perioperative Care University of California-Irvine Adjunct Associate Professor University of Michigan. Technology and Patient Safety. - PowerPoint PPT PresentationTRANSCRIPT
Advances in Non-Invasive Monitoring
Michael O’Reilly, M.D., M.S.Chief Medical OfficerMasimo Corporation
Professor of Anesthesiology and Perioperative CareUniversity of California-IrvineAdjunct Associate Professor
University of Michigan
Technology and Patient Safety
Michael O’Reilly, M.D., M.S.Chief Medical OfficerMasimo Corporation
Professor of Anesthesiology and Perioperative CareUniversity of California-IrvineAdjunct Associate Professor
University of Michigan
Technology Convergence
Monito
ring Information
Communication
Conflict of Interest Statement
Masimo Corporation
The influence of anesthesia care on surgical outcomes
ACS-NSQIP
(ACS=American College of Surgeons)
1
0
2
3
NSQIP Annual Report – FY 2000Mortality O/E Ratios for All Operations
But No Intraoperative Data!No…Estimated Blood Loss (EBL)BP, HR, SPO2, TemperatureDuration of SurgeryUrine Output………Nothing.
But they have 30 Day Outcome.
Surgery meets Anesthesiology
Lancet 2012; 380: 1059–65
European Surgical Outcomes Study (EuSOS) group for the Trials groups of the European Society of Intensive Care Medicine and the European Society of Anaesthesiology
Lancet 2012; 380: 1059–65
Methods:• 7 day cohort study• Consecutive patients aged ≥16 years • Inpatient non-cardiac surgery• 498 hospitals• 28 European nations• Patients followed up to 60 days• Primary endpoint in-hospital mortality• Secondary outcome LOS and ICU
admission
Lancet 2012; 380: 1059–65
Results:• 46 539 patients
• 1855 (4%) died before hospital discharge• 3599 (8%) patients were admitted to critical
care• median LOS of 1・ 2 days (IQR 0・ 9–3・
6) • 1358 (73%) patients who died were not
admitted to critical care at any stage after surgery.
• Crude mortality rates between countries (from 1.2% for Iceland to 21.5% for Latvia)
Lanc
et 2
012;
380
: 105
9–65
Note the Log Scale!
Lancet 2012; 380: 1059–65
Conclusion:The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated.
Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.
From the Michigan Surgical Collaborativefor Outcomes Research and Evaluation,the Department of Surgery, University ofMichigan, Ann Arbor.
n engl j med 361:14; 2009
• 84,730 patients • Inpatient general and vascular surgery• Data from the American College of Surgeons National
Surgical Quality Improvement Program (NSQIP)• Hospitals ranked according to risk-adjusted overall rate of
death• Divided into five groups
Each overall mortality quintile assessed the incidence of overall and major complications and the rate of death among patients with major complications.
METHODS
n engl j med 361:14; 2009
n en
gl j
med
361
:14;
200
9
CONCLUSION“In addition to efforts aimed at avoiding complications in the first place, reducing mortality associated with inpatient surgery will require greater attention to the timely recognition and management of complications once they occur.”
n engl j med 361:14; 2009
Preventing “Failure to Rescue”
Data
We have a lot of data!
Information
But what we really need is information!
Decisions
So we make the right decisions
Actions
Leading to the right action.
DataSensors InformationLight-SpO2
-SpHb
-Cerebral oximetry
-Tissue Oximetry
Electrical-EKG
-EEG
-Impedance
Acoustic
Radar
Ultrasound
EHR Lab
Pharmacy
Sensors Information Decisions ActionsData
Providers
Different roles, different locations
Technology Convergence
Monito
ring Information
Communication
Peter Pronovost, MD
!. Hand washing
2. Full barrier precautions
3. Clean the site with chlorhexidine
4. Avoid the femoral site
5. Remove unnecessary catheters
Preventing CLABSI
“To really make progress, need cooperation of
vendors, clinicians and administrators.”
Implement known patient safety practices.
Get vendors to provide open access to data.
Technology Convergence
Monito
ring Information
Communication
© 2009-2010 Masimo Corporation - CONFIDENTIAL
Critical Care Medicine 2:317; 1974C
© 2009-2010 Masimo Corporation - CONFIDENTIAL
Critical Care Medicine 2:317; 1974C
Liver TransplantContinuous Noninvasive Hemoglobin
A blood transfusion is an organ transplant.
Qian F. Et al. Ann Surg. 2013 Feb;257(2):266-78
Variation of blood transfusion in patients undergoing major non-
cardiac surgery
Goodnough L.T. Shander A. A&A 2012
The 1-3units of RBC transfused
Blood Transfusion: Who is at risk
Remote Monitoring & Clinician Notification System
Anesthesiology 112:284-9; 2010
Transfers to ICU
Comparison Unit 2
Comparison Unit 1 PSN
5.02.6
Anesthesiology 112:284-9; 2010
Reduction in Rescue Calls
PSN Comparison Unit 1 Comparison Unit 2
3.41.0
Taenzer, et al., Anesthesiology 112:284-9; 2010
Significant Financial Implications
Over a 12 month period decreased transfers to the ICU from 54 to 28 for one unit.
With an average LOS of 6.3 days, translates into 163 ICU days saved
© 2012 Masimo Corporation