Abstract
To assess the relationship between the addition of advanced monitoring variables and changes in clinical decision-making. A 15-questions survey was anonymously emailed to international experts and physician members of five anesthesia societies which focused on assessing treatment decisions of clinicians during three realistic clinical scenarios measured at two distinct time points. The first is when typical case information and basic monitoring (T1) were provided, and then once again after the addition of advanced monitoring variables (T2). We hypothesized that the addition of advanced variables would increase the incidence of an optimal therapeutic decision (a priori defined as the answer with the highest percentage of expert agreement) and decrease the variability among the physician’s suggested treatments. The survey was completed by 18 experts and 839 physicians. Overall, adding advanced monitoring did not significantly increase physician response accuracy, with the least substantial changes noted on questions related to volume expansion or vasopressor administration. Moreover, advanced monitoring data did not significantly decrease the high level of initial practice variability in physician suggested treatments (P = 0.13), in contrast to the low variability observed within the expert group (P = 0.039). Additionally, 5–10 years of practice (P < 0.0001) and a cardiovascular subspecialty (P = 0.048) were both physician characteristics associated with a higher rate of optimal therapeutic decisions. The addition of advanced variables was of limited benefit for most physicians, further indicating the need for more in depth education on the clinical value and technical understanding of such variables.
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Acknowledgments
The authors wish to gratefully acknowledge our experts for answering this survey. We are also grateful to the five scientific anesthesia societies (SARB, SFAR, ARCOTHOVA, EACTA and SCA) for supporting this survey and helping to send it to their active members. Lastly, the authors would like to thank all physicians for their participation. IRB: This study has been approved by the IRB of the University of California Irvine (HS#: 2012-8929). This Committee can be reached at irb@rgs.uci.edu.
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This work was supported solely by departmental sources.
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Joseph Rinehart—Ownership interest in Sironis, a company developing closed-loop medical software. Maurizio Cecconi has received within the past 5 years, honoraria and/or travel expenses from Edwards Lifesciences, LiDCO, Cheetah, Bmeye, Masimo and Deltex. Philippe Van der Linden has received, within the past 5 years, fees for lectures and consultancies from Fresenius Kabi GmbH, and Janssen-Cilag SA, Belgium. Maxime Cannesson—Ownership interest in Sironis, a company developing closed-loop medical software. Consultant for Edwards Lifesciences, Masimo Corp, Covidien. All other authors—no conflicts of interest to declare.
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Joosten, A., Desebbe, O., Suehiro, K. et al. Impact of advanced monitoring variables on intraoperative clinical decision-making: an international survey. J Clin Monit Comput 31, 205–212 (2017). https://doi.org/10.1007/s10877-015-9817-1
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DOI: https://doi.org/10.1007/s10877-015-9817-1