The future of the perfusion record: automated data collection vs. manual recording

Abstract

The perfusion record, whether manually recorded or computer generated, is a legal representation of the procedure. The handwritten perfusion record has been the most common method of recording events that occur during cardiopulmonary bypass. This record is of significant contrast to the integrated data management systems available that provide continuous collection of data automatically or by means of a few keystrokes. Additionally, an increasing number of monitoring devices are available to assist in the management of patients on bypass. These devices are becoming more complex and provide more data for the perfusionist to monitor and record. Most of the data from these can be downloaded automatically into online data management systems, allowing more time for the perfusionist to concentrate on the patient while simultaneously producing a more accurate record. In this prospective report, we compared 17 cases that were recorded using both manual and electronic data collection techniques. The perfusionist in charge of the case recorded the perfusion using the manual technique while a second perfusionist entered relevant events on the electronic record generated by the Stockert S3 Data Management System/Data Bahn (Munich, Germany). Analysis of the two types of perfusion records showed significant variations in the recorded information. Areas that showed the most inconsistency included measurement of the perfusion pressures, flow, blood temperatures, cardioplegia delivery details, and the recording of events, with the electronic record superior in the integrity of the data. In addition, the limitations of the electronic system were also shown by the lack of electronic gas flow data in our hardware. Our results confirm the importance of accurate methods of recording of perfusion events. The use of an automated system provides the opportunity to minimize transcription error and bias. This study highlights the limitation of spot recording of perfusion events in the overall record keeping for perfusion management.

Figure 1.

The average number of data points collected in the automatic (spotted bar) vs. manually (striped bar) collected records.

Figure 2.

Example of MAP collected both manually and automatically. MAP is plotted against time for manual (•) and automatic (▪) records.

Figure 3.

Scattergram of minimum and maximum MAP recorded manually and automatically.

Figure 4.

Example of blood flow collected both manually and automatically. Blood flow is plotted against the time for both the manual (•) and automatic records (▪).

Figure 5.

Example of arterial blood temperature measurement collected both manually and automatically. Arterial blood temperature is plotted against time for both the manual (•) and automatic records (▪).

Figure 6.

Scattergram of minimum and maximum arterial outlet temperatures recorded manually and automatically.

Figure 7.

Scattergram of minimum and maximum nasopharyngeal temperature recorded manually and automatically.

Figure 8.

With all 17 cases, the difference in volume delivered between the manual record and the electronic record.