TY - JOUR
T1 - Protocol for the effectiveness of an anesthesiology control tower system in improving perioperative quality metrics and clinical outcomes
T2 - The tectonics randomized, pragmatic trial
AU - King, Christopher R.
AU - Abraham, Joanna
AU - Kannampallil, Thomas G.
AU - Fritz, Bradley A.
AU - Abdallah, Arbi Ben
AU - Chen, Yixin
AU - Henrichs, Bernadette
AU - Politi, Mary
AU - Torres, Brian A.
AU - Mickle, Angela
AU - Budelier, Thaddeus P.
AU - McKinnon, Sherry
AU - Gregory, Stephen
AU - Kheterpal, Sachin
AU - Wildes, Troy
AU - Avidan, Michael S.
AU - Tectonics Research Group, Research Group
N1 - Publisher Copyright:
© 2019 King CR et al.
PY - 2020
Y1 - 2020
N2 - Introduction: Perioperative morbidity is a public health priority, and surgical volume is increasing rapidly. With advances in technology, there is an opportunity to research the utility of a telemedicine-based control center for anesthesia clinicians that assess risk, diagnoses negative patient trajectories, and implements evidence-based practices. Objectives: The primary objective of this trial is to determine whether an anesthesiology control tower (ACT) prevents clinically relevant adverse postoperative outcomes including 30-day mortality, delirium, respiratory failure, and acute kidney injury. Secondary objectives are to determine whether the ACT improves perioperative quality of care metrics including management of temperature, mean arterial pressure, mean airway pressure with mechanical ventilation, blood glucose, anesthetic concentration, antibiotic redosing, and efficient fresh gas flow. Methods and analysis: We are conducting a single center, randomized, controlled, phase 3 pragmatic clinical trial. A total of 58 operating rooms are randomized daily to receive support from the ACT or not. All adults (eighteen years and older) undergoing surgical procedures in these operating rooms are included and followed until 30 days after their surgery. Clinicians in operating rooms randomized to ACT support receive decision support from clinicians in the ACT. In operating rooms randomized to no intervention, the current standard of anesthesia care is delivered. The intention-to-treat principle will be followed for all analyses. Differences between groups will be presented with 99% confidence intervals; p-values <0.005 will be reported as providing compelling evidence, and p-values between 0.05 and 0.005 will be reported as providing suggestive evidence. Registration: TECTONICS is registered on ClinicalTrials.gov, NCT03923699; registered on 23 April 2019.
AB - Introduction: Perioperative morbidity is a public health priority, and surgical volume is increasing rapidly. With advances in technology, there is an opportunity to research the utility of a telemedicine-based control center for anesthesia clinicians that assess risk, diagnoses negative patient trajectories, and implements evidence-based practices. Objectives: The primary objective of this trial is to determine whether an anesthesiology control tower (ACT) prevents clinically relevant adverse postoperative outcomes including 30-day mortality, delirium, respiratory failure, and acute kidney injury. Secondary objectives are to determine whether the ACT improves perioperative quality of care metrics including management of temperature, mean arterial pressure, mean airway pressure with mechanical ventilation, blood glucose, anesthetic concentration, antibiotic redosing, and efficient fresh gas flow. Methods and analysis: We are conducting a single center, randomized, controlled, phase 3 pragmatic clinical trial. A total of 58 operating rooms are randomized daily to receive support from the ACT or not. All adults (eighteen years and older) undergoing surgical procedures in these operating rooms are included and followed until 30 days after their surgery. Clinicians in operating rooms randomized to ACT support receive decision support from clinicians in the ACT. In operating rooms randomized to no intervention, the current standard of anesthesia care is delivered. The intention-to-treat principle will be followed for all analyses. Differences between groups will be presented with 99% confidence intervals; p-values <0.005 will be reported as providing compelling evidence, and p-values between 0.05 and 0.005 will be reported as providing suggestive evidence. Registration: TECTONICS is registered on ClinicalTrials.gov, NCT03923699; registered on 23 April 2019.
KW - Anesthesiology
KW - Artificial Intelligence
KW - Decision Support
KW - Forecasting Algorithms
KW - Machine Learning
KW - Randomized Controlled Trial
KW - Telemedicine
UR - http://www.scopus.com/inward/record.url?scp=85082092554&partnerID=8YFLogxK
U2 - 10.12688/f1000research.21016.1
DO - 10.12688/f1000research.21016.1
M3 - Article
C2 - 32201572
AN - SCOPUS:85082092554
SN - 2046-1402
VL - 8
JO - F1000Research
JF - F1000Research
ER -