A Visual Analytics Dashboard to Summarize Serial Anesthesia Records in Pediatric Radiation Treatment

Abstract

Background: Young children who undergo radiation therapy may require general anesthesia to remain still during weeks of radiation sessions. On a typical day at our hospital, an anesthesia team will care for 10 patients in the radiation therapy suite, and each patient will have multiple prior anesthetic records. Daily review of prior anesthesia records is important to maintain anesthetic consistency and to identify potential improvement, yet our electronic health record (EHR) made such review time-consuming and cumbersome.

Objectives: This article aims to design a visual analytics interface that simultaneously displays data from multiple anesthesia encounters to support clinical consistency in medications and airway management.

Methods: Documentation from the EHR is available in the clinical data warehouse following daily backups. A visual analytics interface was built to aggregate important components of multiple anesthesia encounters in pediatric radiation oncology on a single screen. The application was embedded in the EHR's anesthesia module and updated daily.

Results: Each anesthesia encounter was represented by a vertical line with the date at the bottom of the screen. Each vertical line was divided into sections corresponding to the medications, type of airway device, type of radiation oncology procedure, days between treatments, and recovery score and time. Information about the medications, airways, and procedures was shown with icon legends. This layout enabled users to quickly see the key components of multiple anesthetics and make inferences between, for example, the medications used and the recovery score.

Conclusion: The dashboard provides a high-level summary of all radiation therapy anesthesia records for children receiving recurrent treatments. In this clinical scenario, it is desirable to replicate an optimal anesthetic approach for daily or near-daily treatments or adjust the anesthetic based on observed patterns.

Fig. 1

The production electronic health record (EHR) is backed up to the reporting EHR server with a 24-hour delay. Once documentation is in the EHR server, it is available to the clinical data warehouse (CDW). Data in the CDW is then exported to the visual analytics dashboard daily in the early morning.

Fig. 2

The dashboard is divided into four sections with icon legends: medications, airways, procedures, and recovery score and time. Each anesthetic is represented by a vertical line chronologically from left to right, with the date of each encounter at the bottom of the screen (exact dates removed here). The Medications section includes those commonly used for this type of general anesthetic, with separate icons for sevoflurane, propofol, dexmedetomidine, glycopyrrolate, ondansetron, and vecuronium. Dosage is shown if the mouse cursor is hovered over an icon, as shown by the cursor. The Airway section shows icons for endotracheal tubes (ETTs) or laryngeal mask airways (LMAs) as well as a number corresponding to the size of the device. The Procedures section shows common procedure types performed in pediatric radiation therapy, including computed tomography (CT) simulation (CT-SIM), conventional radiation therapy (XRT), and proton radiation therapy (PROTON). Above the Procedures section, the number of days between treatments is listed to assist with identifying gaps in treatment. The Recovery Score shows the maximum recovery score based on the Watcha scale (1–calm, asleep, 2–calm, can be consoled, 3–crying, cannot be consoled, 4–thrashing and inconsolable). The Recovery Time in minutes is listed above the line representing the Recovery Scale.