A number of improvements relating to methods and apparatuses for kidney dialysis are disclosed. These include checking of dialysate bypass status using flow measurement; using a flow sensor to confirm the absence of ultrafiltration during bypass; automatic testing of ultrafiltration function by removal of a discrete volume from a portion of the dialysate flow path coupled with a pressure test of that part of the flow path; using a touch screen user interface; bar graph profile programming of ultrafiltration, sodium, and bicarbonate parameters; using a RAM card to upload treatment instructions to, and to download treatment data from, the machine; automatic setting of proportioning mode (acetate or bicarbonate) based on connections of concentrate lines; predicting dialysate conductivity values based on brand and formulation of concentrates; minimizing no-flow dead time between dialysate pulses; initiating operation in a timed mode from a machine power-off condition; preserving machine mode during machine power-fail condition; calibration scheduling and reminding; automatic level adjusting; and blood leak flow rate detecting.

Method and apparatus for kidney dialysis

A modified critical-incident analysis technique was used in a retrospective examination of the characteristics of human error and equipment failure in anesthetic practice. The objective was to uncover patterns of frequently occurring incidents that are in need of careful prospective investigation. Forty seven interviews were conducted with staff and resident anesthesiologists at one urban teaching institution, and descriptions of 359 preventable incidents were obtained. Twenty three categories of details from these descriptions were subjected to computer-aided analysis for trends and patterns. Most of the preventable incidents involved human error (82%), with breathing-circuit disconnections, inadvertent changes in gas flow, and drug syringe errors being frequent problems. Overt equipment failures constituted only 14% of the total number of preventable incidents, but equipment design was indictable in many categories of human error, as were inadequate experience and insufficient familiarity with equipment or with the specific surgical procedure. Other factors frequently associated with incidents were inadequate communication among personnel, haste or lack of precaution, and distraction. Results from multi-hospital studies based on the methodology developed could be used for more objective determination of priorities and planning of specific investments for decreasing the risk associated with anesthesia.

Preventable Anesthesia Mishaps: A Study of Human Factors

To evaluate if anesthesia training and experience influenced chart completion and accuracy. One hundred and twenty-four subjects, including medical students, anesthesia residents and community and university based clinical anesthesiologists, were given a standardized patient in a simulator environment and asked to conduct induction and maintenance of anaesthesia. Three critical events were introduced resulting in changes in BR HR, PETCO2 and SpO2. Subjects were instructed to manage the patient and the anesthetic chart, as was their customary practice. Discrepancy, calculated as the difference between the actual and charted values divided by the actual physiological value was compared by level of training with a two-way repeated measures analysis of variance (ANOVA) for all four physiological variables. The completeness of charting, defined as at least one data point recorded for each of the four physiological variables of the three critical events, was compared across level of training, age of participants and number of years in practice. The overall completeness of charting remained low (< 37%) with no relationship based on the anesthesiologist’s age, level of training or number of years in practice. There was discrepancy in charting for all physiological variables (HR, BR PETCO2 and SpO2, P < 0.0001), with a marked difference in the degree of discrepancy within each level of training. Training resulted in no differences in charting discrepancy. Charting of data to the anesthetic record remained incomplete and inaccurate in all groups based on level of training, age and number of years in practice.

/pdf/the-anesthetic-record-accuracy-and-completeness-1rodytl272.pdf

The anesthetic record: accuracy and completeness.

Anesthesia Information Management Systems (AIMS) display and archive perioperative physiological data and patient information. Although currently in limited use, the potential benefits of an AIMS with regard to enhancement of patient safety, clinical effectiveness and quality improvement, charge capture and professional fee billing, regulatory compliance, and anesthesia outcomes research are great. The processes and precautions appropriate for AIMS selection, installation, and implementation are complex, however, and have been learned at each site by trial and error. This collaborative effort summarizes essential considerations for successful AIMS implementation, including product evaluation, assessment of information technology needs, resource availability, leadership roles, and training.

Anesthesia information management system implementation: a practical guide.

We have developed an anesthesia information system (AIS) that supports the anesthesiologist in monitoring and recording during a surgical operation. In development of the system, emphasis was placed on providing an anesthesiologist-computer interface that can be adapted to typical situations during anesthesia and to individual user behavior. One main feature of this interface is the integration of the input and output of information. The only device for interaction between the anesthesiologist and the AIS is a touch-sensitive, high-resolution color display screen. The anesthesiologist enters information by touching virtual function keys displayed on the screen. A data window displays all data generated over time, such as automatically recorded vital signs, including blood pressure, heart rate, and rectal and esophageal temperatures, and manually entered variables, such as administered drugs, and ventilator settings. The information gathered by the AIS is presented on the cathode ray tube in several pages. A main distributor page gives an overall view of the content of every work page. A one-page record of the anesthesia is automatically plotted on a multicolor digital plotter during the operation. An example of the use of the AIS is presented from a field test of the system during which it was evaluated in the operating room without interfering with the ongoing operation. Medical staff who used the AIS imitated the anesthesiologist’s recording and information search behavior but did not have responsibility for the conduct of the anesthetic.

/pdf/an-anesthesia-information-system-for-monitoring-and-record-lfjjnvdzge.pdf

An anesthesia information system for monitoring and record keeping during surgical anesthesia.

Une des exigences principales pour le developpement des systemes de dialogue interactifs ― specialement dans le domaine medical ― est une adaptation de l'interface homme-machine aux capacites cognitives et aux besoins humains, qui est accomplie en se consacrant a la conception materielle et logicielle. Presentation des mesures pour la conception d'une interface ecran de visualisation ergonomique

Entwicklung einer Mensch-Rechner Schnittstelle für ein Anästhesie-Informationssystem unter Berücksichtigung ergonomischer Gesichtspunkte

Durch Berührungseingabe direkt auf einen Bildschirm umgeht der Bediener eines technischen Systems die Eingabe von Information über separate Tastaturen oder andere Bedienelemente. Der MenschMaschine-Dialog dieser Art ist besonders dann sinnvoll, wenn der Mensch vorwiegend prozessüberwachend arbeitet. Bei solchen Tätigkeiten ist ein "intelligentes" technisches System in der Lage, prozessrelevante Information darzustellen und gleichzeitig Alternativen für die Beschaffung ergänzender, vertiefter oder andersartiger Information anzubieten. Hierbei müssen nicht zu jeder Zeit alle Alternativen der Informationsbeschaffung bereitstehen. Deshalb können situationsangepaßte "virtuelle Tastaturen" auf dem Bildschirm gezeigt werden, die der Benutzer mittels Berühren anwählt

Direkter zugriff auf bildschirminformation über berühreingabe (touch input) und anwendung in komplexen klinischen systemen

Design and evaluation of a medical information system for the anaesthesiologist is the research application for which a two-operator design simulation configuration has been set up. A cognitive model is described to derive information structures and task levels for system development and operational simulation. The simulation configuration with the work station under test and the data generation station is described. Simulation objectives and procedures as well as experiments at relatively low task levels are discussed. We conclude that the two-operator simulation configuration with the expert operator in the modelling loop, though human-time-cost intensive helps considerably during the optimization of the human-system-interface and the information structure at different system development stages.

Operation simulation for the evaluation and improvement of a medical information system

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An anesthesia information system for monitoring and record keeping during surgical anesthesia.

Entwicklung einer Mensch-Rechner Schnittstelle für ein Anästhesie-Informationssystem unter Berücksichtigung ergonomischer Gesichtspunkte

Direkter zugriff auf bildschirminformation über berühreingabe (touch input) und anwendung in komplexen klinischen systemen

Operation simulation for the evaluation and improvement of a medical information system

Operation simulation for the evaluation and improvement of a medical information system