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Advances in Non-Invasive Monitoring Michael O’Reilly, M.D., M.S. Chief Medical Officer Masimo Corporation Professor of Anesthesiology and Perioperative.

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Presentation on theme: "Advances in Non-Invasive Monitoring Michael O’Reilly, M.D., M.S. Chief Medical Officer Masimo Corporation Professor of Anesthesiology and Perioperative."— Presentation transcript:

1 Advances in Non-Invasive Monitoring Michael O’Reilly, M.D., M.S. Chief Medical Officer Masimo Corporation Professor of Anesthesiology and Perioperative Care University of California-Irvine Adjunct Associate Professor University of Michigan

2 Technology and Patient Safety Michael O’Reilly, M.D., M.S. Chief Medical Officer Masimo Corporation Professor of Anesthesiology and Perioperative Care University of California-Irvine Adjunct Associate Professor University of Michigan

3 Technology Convergence Monitoring Information Communication

4 Conflict of Interest Statement Masimo Corporation

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7 The influence of anesthesia care on surgical outcomes

8 ACS-NSQIP (ACS=American College of Surgeons)

9 NSQIP Annual Report – FY 2000 Mortality O/E Ratios for All Operations

10 But No Intraoperative Data! No… Estimated Blood Loss (EBL) BP, HR, SPO 2, Temperature Duration of Surgery Urine Output………Nothing. But they have 30 Day Outcome. Surgery meets Anesthesiology

11 Lancet 2012; 380: 1059–65 European Surgical Outcomes Study (EuSOS) group for the Trials groups of the European Society of Intensive Care Medicine and the European Society of Anaesthesiology

12 Lancet 2012; 380: 1059–65 Methods: 7 day cohort study Consecutive patients aged ≥16 years Inpatient non-cardiac surgery 498 hospitals 28 European nations Patients followed up to 60 days Primary endpoint in-hospital mortality Secondary outcome LOS and ICU admission

13 Lancet 2012; 380: 1059–65 Results: patients 1855 (4%) died before hospital discharge 3599 (8%) patients were admitted to critical care median LOS of 1 ・ 2 days (IQR 0 ・ 9–3 ・ 6) 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates between countries (from 1.2% for Iceland to 21.5% for Latvia)

14 Lancet 2012; 380: 1059–65 Note the Log Scale!

15 Lancet 2012; 380: 1059–65 Conclusion: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.

16 From the Michigan Surgical Collaborative for Outcomes Research and Evaluation, the Department of Surgery, University of Michigan, Ann Arbor. n engl j med 361:14; 2009

17 84,730 patients Inpatient general and vascular surgery Data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Hospitals ranked according to risk-adjusted overall rate of death Divided into five groups Each overall mortality quintile assessed the incidence of overall and major complications and the rate of death among patients with major complications. METHODS n engl j med 361:14; 2009

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19 CONCLUSION “In addition to efforts aimed at avoiding complications in the first place, reducing mortality associated with inpatient surgery will require greater attention to the timely recognition and management of complications once they occur.” n engl j med 361:14; 2009

20 Preventing “Failure to Rescue”

21 Data We have a lot of data! Information But what we really need is information! Decisions So we make the right decisions Actions Leading to the right action.

22 DataSensorsInformation Light -SpO 2 -SpHb -Cerebral oximetry -Tissue Oximetry Electrical -EKG -EEG -Impedance Acoustic Radar Ultrasound EHR Lab Pharmacy

23 SensorsInformationDecisionsActionsData Providers Different roles, different locations

24 Technology Convergence Monitoring Information Communication

25 Peter Pronovost, MD

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27 !. Hand washing 2. Full barrier precautions 3. Clean the site with chlorhexidine 4. Avoid the femoral site 5. Remove unnecessary catheters Preventing CLABSI

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29 “To really make progress, need cooperation of vendors, clinicians and administrators.”

30 Implement known patient safety practices. Get vendors to provide open access to data.

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32 Technology Convergence Monitoring Information Communication

33 © Masimo Corporation - CONFIDENTIAL Critical Care Medicine 2:317; 1974C

34 © Masimo Corporation - CONFIDENTIAL Critical Care Medicine 2:317; 1974C

35 Liver Transplant Continuous Noninvasive Hemoglobin

36 A blood transfusion is an organ transplant.

37 Qian F. Et al. Ann Surg Feb;257(2):266-78

38 Goodnough L.T. Shander A. A&A 2012 The 1-3units of RBC transfused

39 Remote Monitoring & Clinician Notification System

40 Halo Display Halo Index has CE Mark

41 Anesthesiology 112:284-9; 2010

42 Transfers to ICU Comparison Unit 2 Comparison Unit 1 PSN Anesthesiology 112:284-9; 2010

43 Reduction in Rescue Calls PSN Comparison Unit 1 Comparison Unit Taenzer, et al., Anesthesiology 112:284-9; 2010

44 Significant Financial Implications Over a 12 month period decreased transfers to the ICU from 54 to 28 for one unit. With an average LOS of 6.3 days, translates into 163 ICU days saved

45 © 2012 Masimo Corporation

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