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Research Article|Articles in Press

Automated Electronic Health Record–Based Application for Sedation Triage in Routine Colonoscopy

Open AccessPublished:February 05, 2023DOI:https://doi.org/10.1016/j.gie.2023.02.001
Automated Electronic Health Record–Based Application for Sedation Triage in Routine Colonoscopy
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      Abstract

      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 utilizing patient data in an automated application within the electronic health record (EHR).

      Methods

      In our practice, we choose between MS or MAC for routine gastrointestinal (GI) procedures according to written anesthesia use guidelines and practitioner preferences. To expedite our decision-making for MS vs MAC, we developed an Excel-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 (0.5%) vs MAC (0.6%) 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. Complication rates and sedation failure did not increase with use of the application. With the increase in use of MS over MAC, health care costs for the more expensive MAC sedation should also decrease.

      Keywords

      Abbreviations:

      ADR (adenoma detection rate), ASGE (American Society of Gastroenterology), CRNA (certified registered nurse anesthetist), EHR (electronic health record), HCSR (high conscious sedation requirement), MAC (monitored anesthesia care), MS (moderate sedation)

      Article info

      Publication history

      Accepted: February 1, 2023
      Received in revised form: January 13, 2023
      Received: November 1, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Conflict of interest: None.

      Sushil Kumar Garg: conception and design; analysis and interpretation of the data; drafting of the article; critical revision of the article for important intellectual content; final approval of the article

      Amy M. Szymoniak: analysis and interpretation of the data; drafting of the article; final approval of the article

      Karen F. Johnson, MA: analysis and interpretation of the data; creation of the tool in Epic; final approval of the article

      Jackqueline K. Vaughn, MA: analysis and interpretation of the data; creation of the tool in Epic; final approval of the article

      John J. Seelman: analysis and interpretation of the data; creation of the tool in Epic; final approval of the article

      Zan Degen, RN: Conception and design; analysis and interpretation of the data; drafting of the article; critical revision of the article for important intellectual content; final approval of the article

      Rajeev Chaudhry, MBBS, MPH: Conception and design; analysis and interpretation of the data; drafting of the article; critical revision of the article for important intellectual content; final approval of the article.

      Publisher: To expedite proof approval, send proof via email to [email protected]

      ©2022 Mayo Foundation for Medical Education and Research

      Identification

      DOI: https://doi.org/10.1016/j.gie.2023.02.001

      Copyright

      © 2023 by the American Society for Gastrointestinal Endoscopy

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