Clinical Decision Support for Perioperative Information Management Systems

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This is a review of the (2013) article “Clinical Decision Support for Perioperative Information Management Systems.” [1]


Clinical decision support (CDS) systems are being used to optimize the increasingly complex care that our health care system delivers. These systems have become increasingly important in the delivery of perioperative care for patients undergoing cardiac, thoracic, and vascular procedures. The adoption of perioperative information management systems (PIMS) has allowed these technologies to enter the operating room and support the clinical work flow of anesthesiologists and operational processes. Constructing effective CDS systems necessitates an understanding of operative work flow and technical considerations as well as achieving integration with existing information systems. In this review, we describe published examples of CDS for PIMS, including support for cardiopulmonary bypass separation physiological alarms, β-blocker guideline adherence, enhanced revenue capture for arterial line placement, and detection of hemodynamic monitoring gaps. Although these and other areas are amenable to CDS systems, the challenges of latency and data reliability represent fundamental limitations on the potential application of these tools to specific types of clinical issues. Ultimately, we expect that CDS will remain an important tool in our efforts to optimize the quality of care delivered.

Article Summary

Background: Increasingly, hospitals and organizations have used “Perioperative Information Management Systems” (PIMS). With growing advancements in technology, there has been more inclusion of Clinical Decision Support (CDS) within these systems. The combination of these 2 technologies allows for increased reliability and accuracy, while also increasing the information able to be actively retrieved quickly.

Examples: CDS can be effectively used to notify clinicians of physiological abnormalities, in addition to continuously monitoring the patient quickly. CDS also is able to improve the administration of medications both pre and intra-operatively; studies still need to be done to evaluate the effect of postoperative medication administration. Finally, another use for CDS in the perioperative setting has been found to be increasing revenues.

Limitations: Latency and alarm fatigue are two main concerns for the use of CDS in conjunction with PIMS. Because the perioperative department is quickly changing and patients are so closely monitored, there is the likely possibility that by the time the computer systems detect and notify the clinicians, the alert has already been addressed and resolved.

Conclusions: In the future, it is likely that these modes of technology will continued to be used and with increased in functionality.

Article Analysis

This meta-analysis article, looks specifically at the use of PIMS in association with CDS by anesthesia teams in the perioperative setting. While this review does not look directly at one study, it brings in many studies and experiences throughout the nation, regarding the effectiveness of this combination system. The use of CDS is a great tool in the setting and has the possibility of increasing productivity and effectiveness of the perioperative area. Increased revenues, increased compliance to national standards, and improved patient medication rates are just a few of the ways that CDS has been proven to be specifically advantageous to the perioperative setting.


One of the companies that provides PIMS is MEDHOST.


  1. Wanderer, J., & Ehrenfeld, J. (2013). Clinical Decision Support for Perioperative Information Management Systems. Seminars in Cardiothoracic and Vascular Anesthesia, 17(4), 288-293. doi:10.1177/1089253213490078