Will a Real Time Advisory for Double Low State Change Clinical Behavior and Impact Outcomes

• Mortality [ Time Frame: at 90 days ] [ Designated as safety issue: No ]
  

• Response to Notification [ Time Frame: Intraoperative ] [ Designated as safety issue: No ]
  proportion of anesthesia teams that respond to a double low event with either a vasopressor or decrease in the dose of volatile anesthetic
  
  
• Effect of response [ Time Frame: Intraoperative ] [ Designated as safety issue: No ]
  An evaluation as to whether the response elicited resulted in less double low physiology
  
  

Data that is routinely collected as part of standard of care intraoperative monitoring including blood pressure, amount of anesthetic administered and a form of processes electroencephalogram called the bispectral index, which is a measure of depth of anesthesia all enter in an electronic record keeper. This project monitors for a combination of a blood pressure below mean of 75mmHg and a BIS of 45. When this is detected, half of the anesthesiologists caring for patients receive a text message on the computer screen and their pagers indicating that a double low situation exists and that they should consider intervening. The other half of practitioners are not provided with the additional messages, although all of the same information is available in the operating room (OR). Most patients undergoing general non-cardiac anesthesia at Mount Sinai are eligible. Documentation of consent was waived. All patients are informed of the ongoing project upon admission and are given a variety of methods of opting out of the project.

The analysis seeks to determine if the messages were effective at influencing clinician behavior and whether that change would make a difference in either length of stay or 90 day mortality.