The Impact of a Real-Time Locating System within the Perioperative Environment on Physicians and Patients' Families.

BACKGROUND: Humber River Hospital has implemented a real-time location system (RTLS) within the operating room in order to provide real-time information about patients' status and manage the many components involved during the perioperative journey. OBJECTIVE: The aim of this study was to explore both physicians' and family members' perceptions of the functionality and efficiency of the RTLS within the perioperative environment. METHODS: Semi-structured interviews were conducted with physicians and patients' family members to elicit various perspectives regarding the use of RTLSs throughout the perioperative process. Interviews were recorded and transcribed to extract key themes. RESULTS: Three themes gleaned from physician interviews were system weaknesses, perceptions of potential benefit, and benefits to family members. Three themes uncovered from family member interviews included convenience, ameliorating anxiety, and reducing interruptions. CONCLUSION: Overall, physicians reported that the RTLS had potential to enhance workflow but that significant improvement regarding its implementation and use was needed to reach its full benefit. Family members were unanimous that it provides them with all the tracking information they desire.

Descripción de las herramientas de comunicación utilizadas en el área quirúrgica y la perspectiva de los instrumentadores quirúrgicos / Description of communication tools practices in the surgical area and the perspective of surgical instrumenters

La comunicación efectiva dentro de las organizaciones es uno de los factores más importantes para lograr un trabajo positivo y eficaz. Se realizó una investigación cuyo objetivo fue identificar y describir las herramientas de comunicación en el área de Quirófano Central del Hospital Italiano de Buenos Aires y las distintas perspectivas de los instrumentadores quirúrgicos respecto de su utilización. Métodos: se realizó un estudio de corte transversal con un componente de observación participativa de los medios de comunicación y una encuesta a los instrumentadores quirúrgicos de la institución. Resultados: se identificaron ocho tipos de herramientas de comunicación en el área quirúrgica. El correo electrónico (e-mail) como herramienta de comunicación es muy utilizado según los instrumentadores quirúrgicos, pero estos sugirieron otras herramientas más directas, como reuniones y capacitaciones solas o en combinación para determinados tipos de información. Conclusiones: los instrumentadores quirúrgicos utilizan una amplia gama de medios de comunicación en el área quirúrgica. La distribución de preferencias según el tipo de información indica que la elección de estos medios debería ser personalizada. (AU)

Effective communication within organizations is one of the most important factors to achieve a positive and effective work. An investigation was carried out and its objective was to identify and describe the communication tools in the surgical area of the Hospital Italiano de Buenos Aires and the different perspectives of the surgical nurses regarding its use. Methods: a cross-sectional study was carried out with a component of participative observation of the communication tools and a survey of the surgical nurses of the institution. Results: eight types of communication tools were identified in the surgical area. The implementation of email as a communication tool is widely used by surgical nurses, but they suggested other more direct tools such as meetings and training sessions alone or in combination for certain types of information. Conclusions: Surgical nurses use a wide range of communication tools in the surgical area. The distribution of preferences according to the type of information indicates that the choice of these tools should be personalized. (AU)

An evaluation of perioperative communication in the operating room.

Communication failures can lead to sentinel events in the operating room. Knowledge of basic surgical steps is important for all team members to ensure work flow efficiency. Surgeons and non-surgeons were surveyed to determine perceived and actual quality of communication between team members, using knowledge of surgical steps as a marker of communication quality. Participants agreed that communication was important, but non-surgeons were unable to name the four key steps of a laparoscopic cholecystectomy (p = 5.0E-07), indicating poor communication between surgeons and non-surgeons.

Modelling of Operative Report Documents for Data Integration into an openEHR-Based Enterprise Data Warehouse.

In order to integrate operative report documents from two operating room management systems into a data warehouse, we investigated the application of the two-level modelling approach of openEHR to create a shared data model. Based on the systems' analyses, a template consisting of 13 archetypes has been developed. Of these 13 archetypes, 3 have been obtained from the international archetype repository of the openEHR foundation. The remaining 10 archetypes have been newly created. The template was evaluated by an application system expert and through conducting a first test mapping of real-world data from one of the systems. The evaluation showed that by using the two-level modelling approach of openEHR, we succeeded to represent an integrated and shared information model for operative report documents. More research is needed to learn about the limitations of this approach in other data integration scenarios.

A Web-Based Operating Room Management Educational Tool.

In 2010, our department instituted a nonclinical, administrative rotation in operating room management for anesthesiology residents. Subsequently, we mandated the rotation for all senior anesthesiology residents in 2013. In 2014, under the auspices of the American Society of Anesthesiologists, we developed a web-based module covering the basics of finance, accounting, and operating room management. A multiple-choice test was given to residents at the beginning and end of the rotation, and we compared the mean scores between residents who took the traditional course and residents who took the web-based module. We found no significant difference between the groups of residents, suggesting that the web-based module is as effective as traditional didactics.

Influence of Data and Formulas on Trust in Information from Journal Articles in an Operating Room Management Course.

To make good decisions, operating room (OR) managers often act autocratically after obtaining expert advice. When such advice is provided by e-mail, attachments of research articles can be included. We performed a quasi-experimental study using an evaluation of 4 articles used in a 50-hour OR management course to assess how their content influences trust in the article's content, including its quality, usefulness, and reliability. There were (a) 2 articles containing data with specific examples of application for health systems and 2 without and (b) 2 articles containing appendices of formulas and 2 without. Some of the formulas in the readings were relatively complicated (e.g., stochastic optimization using the Lagrange method) and unlikely to be used by the subjects (i.e., they show what does not need to be done). Content complexity (±data, ±formulas) served both as sources of limitation in understanding the content and potentially as peripheral cues influencing perception of the content. The 2-page evaluation forms were generated with random sequences of articles and response items. The N = 17 subjects each completed 9 items about each of the 4 articles (i.e., answered 36 questions). The 9-item assessment of trust provided a unidimensional construct (Cronbach α, 0.94). Formulas in the articles significantly increased trust in the information (P = 0.0019). Presence of data did not significantly influence trust (P = 0.15). Therefore, when an expert sends e-mail to a manager who has completed this basic OR management science and asks a question, choosing a paper with formulas has no disadvantage.

Quality of Supervision as an Independent Contributor to an Anesthesiologist's Individual Clinical Value.

BACKGROUND: Although the clinical (operating room) production of individual anesthesiologists has been measured in multiple related ways (e.g., hours of direct clinical care), the same is not true for the quality of that effort. In our study, we consider the quality of clinical supervision provided by anesthesiologists who are supervising anesthesia residents and nurse anesthetists. The quality of the daily supervision can be measured reliably and validly using the scale developed by de Oliveira Filho et al. If clinical production and supervisory quality were not positively correlated, then it would be important for departments to measure the quality of clinical supervision because, essentially, the clinical value provided by an anesthesiologist would be correlated with, but not necessarily proportional to, their clinical hours. METHODS: Our department sends daily e-mail requests to anesthesia residents and nurse anesthetists to evaluate the supervision provided by each anesthesiologist with whom they worked the previous day in an operating room setting. We compared anesthesiologists' clinical activity (total operating room hours) and supervision scores obtained during the first (July 1, 2013 to December 31, 2013) and last (July 1, 2014 to December 31, 2014) of 3 consecutive 6-month periods. During the first 6 months, anesthesiologists received no feedback regarding the supervision scores. During the last 6 months, there was feedback to all anesthesiologists regarding their individual supervision scores and comments provided by residents (during the preceding 6 months) and nurse anesthetists (during the preceding 12 months). RESULTS: Anesthesiologists' mean supervision scores were not positively correlated with their total (weekly) hours of clinical activity. For the first 6 months, the correlations were r = -0.18 among scores provided by residents (P = 0.92 for positive correlation, N = 57 anesthesiologists) and r = -0.04 among scores provided by nurse anesthetists (P = 0.70, N = 61). For the last 6 months, the correlations were r = -0.28 (P = 0.98) and r = -0.10 (P = 0.79), respectively. Pairwise by anesthesiologist, the mean supervision scores provided by residents increased by 0.08 ± 0.01 points (P < 0.0001, N = 44). The mean supervision scores provided by nurse anesthetists increased by 0.28 ± 0.02 points (P < 0.0001, N = 49). CONCLUSIONS: When anesthesiologists supervise anesthesia residents and nurse anesthetists, the amount of clinical work performed and the quality of the supervision provided do not necessarily follow one another. Thus, faculty supervision scores serve as an independent measure of the contribution of an individual anesthesiologist to the care of the patient. Furthermore, when supervision quality is monitored and feedback is provided to anesthesiologists, quality can increase. The results suggest that anesthesiology department managers should not only be monitoring (and perhaps reporting) the quality of their departments' level of supervision, but also establishing processes so that individual anesthesiologists can learn about the quality of supervision they provide.

Towards communication requirements in the operating room and clinic IT.

Today, connecting medical devices to the hospital network becomes a priority for many hospitals. User and operator requirements for communication must be considered in order to develop an adequate interoperable integration approach. This paper conducts a requirement study using questionnaires and working groups investigating 16 clinical communication requirements for connecting medical devices with each other and with clinical IT systems. Six German Hospitals order the communication requirements by their clinical relevance and categorize those into four main clusters. Communication requirements regarding accurate data transfer and processing for patients and devices have top priority, while communication requirements regarding remote manipulation of medical devices have low rank. Connecting medical devices to clinical IT systems improves clinical documentation and with it patient care processes.

Management implications for the perioperative surgical home related to inpatient case cancellations and add-on case scheduling on the day of surgery.

BACKGROUND: The American Society of Anesthesiologists has embraced the concept of the Perioperative Surgical Home as a means through which anesthesiologists can add value to the health systems in which they practice. One key listed element of the Perioperative Surgical Home is to support "scheduling initiatives to reduce cancellations and increase efficiency." In this study, we explored the potential benefits of the Perioperative Surgical Home with respect to inpatient cancellations and add-on case scheduling. We evaluated 6 hypotheses related to the timing of inpatient cancellations and preoperative anesthesia evaluations. METHODS: Inpatient cancellations were studied during 26 consecutive 4-week intervals between July 2012 and June 2014 at a tertiary care academic hospital. All timestamps related to scheduling, rescheduling, and cancellation activities were retrieved from the operating room (OR) case scheduling system. Timestamps when patients were seen by anesthesia residents were obtained from the preoperative evaluation system database. Batch mean methods were used to calculate means and SE. For cases cancelled, we determined whether, for "most" (>50%) cancellations, a subsequent procedure (of any type) was performed on the patient within 7 days of the cancellation. Comparisons with most and other fractions were assessed using the 1 group, 1-sided Student t test. We evaluated whether a few procedures were highly represented among the cancelled cases via the Herfindahl (Simpson's) index, comparing it with <0.15. The rate of scheduling activity was assessed by computing the number of OR scheduling office decisions in each 1-hour bin between 6:00 AM and 3:59 PM. These values were compared with ≥1 decision per hour at the study hospital. RESULTS: Data from 24,735 scheduled inpatient cases were assessed. Cases cancelled after 7 AM on the day before or at any time on the scheduled day of surgery accounted for 22.6% ± 0.5% (SE) of the scheduled minutes all scheduled cases, and 26.8% ± 0.4% of the case volume (i.e., number of cases). Most (83.1% ± 0.6%, P < 10) cases performed were evaluated on the day before surgery. Most (67.6% ± 1.6%, P < 10) minutes of cancelled cases were evaluated on the day before surgery. Most (62.3% ± 1.5%, P < 10) cases were seen earlier than 6:00 PM of the day before surgery. The Herfindahl index among cancelled procedures was 0.021 ± 0.001 (P < 10 compared not only to <0.15 but also to <0.05), showing large heterogeneity among the cancelled procedures. A subsequent procedure was not performed for most cancelled cases (50.6% ± 0.9% compared with >50%, P = 0.12), implying that the indication for the cancelled procedure no longer existed or the patient/family decided not to proceed with surgery. When only cancellations on the scheduled day of surgery were considered, the cancellation rate was 14.0% ± 0.3% of scheduled inpatient minutes and 11.8% ± 0.2% of scheduled inpatient cases. There were 0.59 ± 0.02 OR schedule decisions per hour per 10 ORs between 6:00 AM and 3:59 PM (P < 10, corresponding to ≥1 decision per hour at the 36 OR study hospital). CONCLUSIONS: The study hospital had a high inpatient cancellation rate, despite the fact that most patients whose cases were cancelled were seen by an anesthesia resident by 6:00 PM of the day before surgery. This finding suggests that further efforts to reduce the cancellations by seeing patients sooner on the day before surgery, or seeing even more patients the day before surgery, would not be an economically useful focus of the Perioperative Surgical Home. The wide heterogeneity among cancelled cases indicates that focusing on a few procedures would not materially affect the overall cancellation rate. The relatively low rate of subsequent performance of a procedure on patients whose cases had been cancelled suggests that trying to decrease the cancellation rate might be medically counterproductive. The hourly rate of decisions in the scheduling office during regular work hours on the day of surgery highlights the importance of decisions made at the OR control desk and scheduling office throughout the day to reduce the hours of overused OR time. These data suggest that efforts of the Perioperative Surgical Home related to inpatient cancellations should focus on management decision-making to mitigate the disruptions to the planned OR schedule caused by inpatient case cancellations and add-on cases, more so than on efforts to reduce inpatient cancellation rates.

Positioning patient status monitors in a family waiting room.

OBJECTIVE: To determine where to place patient status displays for family members in the operating room family waiting room at The Children's Hospital of Philadelphia. METHODS: We calculated the percentage of seats from which wall monitors placed in hypothetical positions would be usable. We validated the usability of the new monitors by observing nonemployees' use of monitors in the waiting room 1 week before and 1 week after implementation. RESULTS: Compared to the legacy monitor, the new monitors were observed to be used from more locations within the waiting room and more people were observed to use the new monitors soon after entering the waiting room. CONCLUSIONS: Seemingly trivial decisions like where in a waiting room to place monitors can be informed by careful data collection and the consequences can observably impact communication between hospital staff and family members waiting for loved ones in surgery.

Context mediated usability testing.

Usability testing is an important part of health information technology HIT design. However, usability issues will vary by the contexts where a system is used. To date there are few studies that have described contextual factors of usability testing. This paper uses a case study of a surgical information system to develop a model of four contextual categories that impact usability testing. We discuss each of the contexts in detail and then suggest how they can be used to develop a general framework to enable better understanding of the role of context in usability testing and evaluation of HIT.

[Quality of documentation of intraoperative and postoperative complications : improvement of documentation for a nationwide quality assurance program and comparison with routine data]. / Dokumentationsqualität intra- und postoperativer Komplikationen : Verbesserung der Dokumentation für die verpflichtende Qualitätssicherung und Vergleich mit DRG-Routinedaten.

INTRODUCTION: Complications after cholecystectomy are continuously documented in a nationwide database in Germany. Recent studies demonstrated a lack of reliability of these data. The aim of the study was to evaluate the impact of a control algorithm on documentation quality and the use of routine diagnosis coding as an additional validation instrument. METHODS: Completeness and correctness of the documentation of complications after cholecystectomy was compared over a time interval of 12 months before and after implementation of an algorithm for faster and more accurate documentation. Furthermore, the coding of all diagnoses was screened to identify intraoperative and postoperative complications. RESULTS AND DISCUSSION: The sensitivity of the documentation for complications improved from 46 % to 70 % (p = 0.05, specificity 98 % in both time intervals). A prolonged time interval of more than 6 weeks between patient discharge and documentation was associated with inferior data quality (incorrect documentation in 1.5 % versus 15 %, p < 0.05). The rate of case documentation within the 6 weeks after hospital discharge was clearly improved after implementation of the control algorithm. Sensitivity and specificity of screening for complications by evaluating routine diagnoses coding were 70 % and 85 %, respectively. The quality of documentation was improved by implementation of a simple memory algorithm.

Validez de un método fotométrico de medición de partículas en aire para el control de quirófanos y otras salas de ambiente controlado en los hospitales / Validity of a photometric method of counting particles in air for control of operating rooms and clean rooms in hospitals

Objetivo: Validar un sistema de medici¨®n fotom¨¦trica de part¨ªculas en aire para realizar los controles de bioseguridad ambiental de quir¨®fanos y otras salas de ambiente controlado en los hospitales. Material y m¨¦todos: Se realizaron un total de 144 mediciones pareadas de aire, 88 en ocho quir¨®fanos con sistemas de ventilaci¨®n convencional y tres niveles de filtraci¨®n y 56 en nueve habitaciones sin instalaciones de ventilaci¨®n. Se midieron part¨ªculas de entre 0,1 a 10 ¦Ìm en mg/m3 por m¨¦todo fotom¨¦trico. Simult¨¢neamente, en cada sala se realiz¨® impacto de aire en placas de Petri con medio de cultivo mediante aparato aspirador de cabezal perforado, obteniendo tras cinco d¨ªas de incubaci¨®n recuento de unidades formadoras de colonias (UFC)/1000L. Finalmente se realiz¨® el c¨¢lculo de los puntos de corte ¨®ptimos para la medici¨®n de part¨ªculas mediante Curvas ROC para discriminar tres niveles de contaminaci¨®n. Resultados: El coeficiente de correlaci¨®n entre las dos mediciones fue 0,779 (p<0,001). Los puntos de corte fueron para 0 UFC. 0,015, para >=10 UFC, 0,037, y para >=100 UFC, 0,053. La sensibilidad para estos puntos fue de 95,83%,100% y 100%, y los ¨ªndices Kappa registraron 0,51, 0,88 y 0,75 respectivamente. Conclusi¨®n: En nuestro estudio la correlaci¨®n entre las medidas es notable; la medici¨®n fotom¨¦trica de part¨ªculas puede ser una alternativa para llevar a cabo alguno de los controles rutinarios de bioseguridad (AU)

Objective: Validate a photometric on-air particle measurement system in order to perform ambient bio-security checks in operating rooms and other clean rooms within hospitals. Material and methods: A total of 144 coupled air samples were performed, 88 in 8 different operating rooms with conventional ventilation systems and 3-level filtering and 56 in 9 different rooms without specific ventilation systems. Particles were measured in size between 0,1 to 10 ¦Ìm with the photometric system in mg/m3. Simultaneously in the rooms are performed the sampling air method with impact on culture media. Incubation period is 5 days and count is performed in colony-forming units (CFU/1000L). Finally, optimal cut-points in particles measure were calculated using ROC curves in order to discriminate the three different contamination levels. Results: Spearma´s correlation coefficient was 0,779 p<0,001. Sensitivity for cut-points in particle counting for the different contamination levels was 95,83% ,100% and 100% respectively, and the corresponding Kappa indexes were 0,51; 0,88 and 0,75. Conclusion: Correlation among measurements is notable. Particle measurement can be a worthy alternative for some of the routine bio-security checks (AU)

Decision support using anesthesia information management system records and accreditation council for graduate medical education case logs for resident operating room assignments.

Our goal in this study was to develop decision support systems for resident operating room (OR) assignments using anesthesia information management system (AIMS) records and Accreditation Council for Graduate Medical Education (ACGME) case logs and evaluate the implementations. We developed 2 Web-based systems: an ACGME case-log visualization tool, and Residents Helping in Navigating OR Scheduling (Rhinos), an interactive system that solicits OR assignment requests from residents and creates resident profiles. Resident profiles are snapshots of the cases and procedures each resident has done and were derived from AIMS records and ACGME case logs. A Rhinos pilot was performed for 6 weeks on 2 clinical services. One hundred sixty-five requests were entered and used in OR assignment decisions by a single attending anesthesiologist. Each request consisted of a rank ordered list of up to 3 ORs. Residents had access to detailed information about these cases including surgeon and patient name, age, procedure type, and admission status. Success rates at matching resident requests were determined by comparing requests with AIMS records. Of the 165 requests, 87 first-choice matches (52.7%), 27 second-choice matches (16.4%), and 8 third-choice matches (4.8%) were made. Forty-three requests were unmatched (26.1%). Thirty-nine first-choice requests overlapped (23.6%). Full implementation followed on 8 clinical services for 8 weeks. Seven hundred fifty-four requests were reviewed by 15 attending anesthesiologists, with 339 first-choice matches (45.0%), 122 second-choice matches (16.2%), 55 third-choice matches (7.3%), and 238 unmatched (31.5%). There were 279 overlapping first-choice requests (37.0%). The overall combined match success rate was 69.4%. Separately, we developed an ACGME case-log visualization tool that allows individual resident experiences to be compared against case minimums as well as resident peer groups. We conclude that it is feasible to use ACGME case-log data in decision support systems for informing resident OR assignments. Additional analysis will be necessary to assess the educational impact of these systems.

Concept and design engineering: endourology operating room.

PURPOSE OF REVIEW: A dedicated operating room with fluoroscopic imaging capability and adequate data connectivity is important to the success of any endourology program. Proper understanding of the recent developments in technology in relation to operating room is necessary before planning an endourology operating room. RECENT FINDINGS: An endourology operating room is a fluorocompatible operating room with enough space to accommodate equipment like multiple flat monitors to display video, C-arm with its monitor, ultrasonography machine, laser machine, intracorporeal lithotripsy unit, irrigation pumps and two large trolleys with instruments. This operating room is integrated with devices to continuously record and archive data from endovision and surface cameras, ultrasound and fluoroscopy. Moreover, advances made in data relay systems have created seamless two-way communication between the operating room and electronic medical records, radiological picture archiving and communication system, classroom, auditorium and literally anywhere in the world. SUMMARY: A dedicated endourology operating room is required for any hospital, which has a significant amount of endourology procedures. A custom-made integrated endourology operating room will facilitate endourology procedures, smoothen the workflow in operating room and improve patient outcomes. Meticulous planning and involving experts in the field are critical for the success of the project.

[Interface interconnection and data integration in implementing of digital operating room].

The digital operating-room, with highly integrated clinical information, is very important for rescuing lives of patients and improving quality of operations. Since equipments in domestic operating-rooms have diversified interface and nonstandard communication protocols, designing and implementing an integrated data sharing program for different kinds of diagnosing, monitoring, and treatment equipments become a key point in construction of digital operating room. This paper addresses interface interconnection and data integration for commonly used clinical equipments from aspects of hardware interface, interface connection and communication protocol, and offers a solution for interconnection and integration of clinical equipments in heterogeneous environment. Based on the solution, a case of an optimal digital operating-room is presented in this paper. Comparing with the international solution for digital operating-room, the solution proposed in this paper is more economical and effective. And finally, this paper provides a proposal for the platform construction of digital perating-room as well as a viewpoint for standardization of domestic clinical equipments.

Standardizing implementation of a surgical information system in Danish hospitals--a comparative study.

Implementation of IT-systems in modern healthcare organizations is associated with large, complex, and expensive projects. Purchase of the system is costly, but resources used to implement the organizational changes that follow, can be extensive. In an attempt to reduce costs, and at the same time to provide a thorough basis for local implementation, Corporate IT in The Capital Region of Denmark developed a standardized system-specific implementation concept for use by the hospitals' local implementations of a Surgical Information system. The system has been implemented in five hospitals within the Capital Region. Through document analysis and interviews with the local project managers, we investigated the use and effectiveness of the standardized implementation concept across five hospitals involved. The study shows that total resource requirements and duration of projects are difficult to compare due to different constructions of the project organizations. We conclude that the implementation concept supports local IT-implementations, but parts of the concept are difficult to translate into practice, while other parts are directly operational.

Reliability of clinical coding of hip facture surgery: implications for payment by results?

In our hospital all operative procedures are coded using the OPCS 4.3 classification and in addition are entered into an independent theatre databases. Using these two databases we identified patients undergoing hip fracture surgery at this hospital between 1st November 2003 and 30th November 2006. We identified 408 cases. No single database identified all 408 cases. A quarter of cases (N=98) were not procedurally coded. Only 43.2% (N=176) of cases were recorded in both the theatre database and procedurally coded at the time of this study. Overall the coding accuracy of these 176 cases was 93.8%. Clinical coding at this hospital was unreliable and inaccurate, which has major implications for national statistics, performance analysis and most importantly Payment by Results. We discuss this further and offer possible solutions to improve the coding process.

Manual editing of automatically recorded data in an anesthesia information management system.

BACKGROUND: Anesthesia information management systems allow automatic recording of physiologic and anesthetic data. The authors investigated the prevalence of such data modification in an academic medical center. METHODS: The authors queried their anesthesia information management system database of anesthetics performed in 2006 and tabulated the counts of data points for automatically recorded physiologic and anesthetic parameters as well as the subset of those data that were manually invalidated by clinicians (both with and without alternate values manually appended). Patient, practitioner, data source, and timing characteristics of recorded values were also extracted to determine their associations with editing of various parameters in the anesthesia information management system record. RESULTS: A total of 29,491 cases were analyzed, 19% of which had one or more data points manually invalidated. Among 58 attending anesthesiologists, each invalidated data in a median of 7% of their cases when working as a sole practitioner. A minority of invalidated values were manually appended with alternate values. Pulse rate, blood pressure, and pulse oximetry were the most commonly invalidated parameters. Data invalidation usually resulted in a decrease in parameter variance. Factors independently associated with invalidation included extreme physiologic values, American Society of Anesthesiologists physical status classification, emergency status, timing (phase of the procedure/anesthetic), presence of an intraarterial catheter, resident or certified registered nurse anesthetist involvement, and procedure duration. CONCLUSIONS: Editing of physiologic data automatically recorded in an anesthesia information management system is a common practice and results in decreased variability of intraoperative data. Further investigation may clarify the reasons for and consequences of this behavior.