A September 2019 Anesthesia and Analgesia article looks at the ability to marry improving remote monitors and evolving artificial intelligence to expand and fine-tune the real-time data available to anesthesia providers. Building on remote surveillance capabilities in other medical specialties, this technology may be adapted to greatly enhance the information flow in the perioperative period. The benefits of larger and more diverse data sets are only valuable to clinicians if they can be distilled to a manageable number of high-yield alerts in a time frame in which intervention can change patient care and outcomes. In the traditional anesthetizing environment, artifact and inherent variability in vital signs leads to numerous alarm triggers and “alarm fatigue”. Utilization of intelligent systems offers the capability of recognizing artifactual patterns and increasing the sensitivity to clinically important events but also, and perhaps most importantly, to increase specificity to reduce alarm fatigue.
The article addresses the potential of this technology throughout the perioperative period. Intraoperatively, anesthesiologists remote to the operating room may be aided by technology that continually and intelligently assesses the patient for signs of deterioration and alerts them instantly when such an event occurs, augmenting the ability of the anesthesiologist to supervise the care of multiple patients at once. Studies are underway to assess the impact of monitoring operating room anesthesia care in real-time, to identify practices that diverge from evidence-based approaches, and to provide intraoperative support to staff. The study designers characterize the software as enabling the anesthesiologist to perform a version of air traffic control.
Preoperatively, remote surveillance technology can offer objective data showing functional capacity, exercise tolerance, etc. The challenge will be to reliably collect data from remote monitoring devices, and to turn that data into easily digestible, actionable data on the part of anesthesia providers. Likewise, postoperatively, remote surveillance and alerting systems may enable anesthesiologists to remain involved in complex patients’ immediate postoperative care when physiological decline occurs. Intelligent systems can combine patterns from multiple monitors prior to sending an alarm to the anesthesia provider – again, helping to reduce alarm fatigue.
The authors conclude,” The convergence of recent developments in healthcare information technology and monitoring have opened the door for remote surveillance systems that provide meaningful patient alerts. In all settings of the pre-, intra-, and postoperative continuum, patient care may benefit from such systems. Anesthesiologists have an opportunity to lead the development of these systems.”
EHC NOTE: Artificial Intelligence and Machine Learning is creeping into many aspects of our daily lives. Our cars have lane assist, intelligent cruise control and are “learning” to drive themselves. Amazon, Google and Netflix seem to know our interests and preferences at least as well as we do. Why not apply computer generated insight and “intelligence” to the perioperative environment? In a busy operating room with anesthesia providers involved in numerous procedures, as well as being responsible for patients in the pre- and post-op areas, the amount of information to process is daunting. Allowing computers to analyze, consolidate and format this information to facilitate decision making and priorities is a natural evolution of perioperative care (not only for anesthesia providers, but all perioperative stakeholders).
We certainly support studies of the clinical and operational impact of intelligent technology throughout the perioperative period and believe that the future will inevitably be shaped by its use. A natural extension of that adoption will be to question how technology impacts anesthesia coverage models. Medical direction rules are unchanged from the 20th century. Does value added artificial intelligence allow medical directing physicians to expand their coverage ratios? If a provider can have real-time feeds from multiple operating rooms along with smart alarms on their phone, can they medically direct 1:5, 1:8, 1:X? Does a field model of coverage make more sense? Could anesthesia be monitored from a truly remote site along the lines of a tele-ICU? Do we collectively have a choice to reassess anesthesia models as the number of anesthetizing locations continues to expand at a higher rate than the available provider pool? We believe that these questions and many more will be raised as technology continues its inexorable march towards perioperative intelligence, as anesthetizing locations expand, as demographics expands the ranks of the elderly and as anesthesia providers get spread thinner and thinner.