Digitization of Surgical Flowsheets

Five billion people, from disproportionately low and middle-income countries, are unable to access safe, timely, and affordable surgical and anesthesia care [1]. Patients in Africa are twice as likely to die after surgery when compared with the global average for postoperative deaths [2]. Given most of this mortality happens after surgery, perioperative mortality rate (POMR) has been identified by the World Health Organization as a global measure of the quality of surgical procedures. Perioperative data collected during surgery can predict adverse surgical outcomes. Access to such data is essential for decreasing mortality rates and improving medical treatment. In many low and middle-income countries, data is often manually recorded on paper flowsheets, restricting the ability to discover medical trends and inhibiting easy and efficient data aggregation and analysis. Thus, systems put in place to digitize these flowsheets are key in utilizing data to improve overall healthcare. By streamlining the digitization of intraoperative flowsheets, more data will be collected while minimizing the time while optimizing the quality. In order to optimize the digitization process, the research team has made several improvements to the current system, including a complete redesign of the digital upload process in the form of a mobile app that integrates scanner functionality and upload capability into one convenient and efficient step, thereby reducing devices and platforms required to upload. This redesign also provides increased user feedback and corrects issues in which flowsheet uploads failed. In addition, improvements were made to the SARA (Scanning Apparatus for Remote Access). SARA is a wooden box designed to standardized the distance, lighting, and background for each scan, improving readability. Possible replacement power supplies and lighting sources are being examined for durability, ease of repair, and functionality. Additionally, usability testing and evaluation was completed to measure increases in successful task completion and decreases in time and steps required. The goal of this project is to design a system to digitize the information contained in surgical flowsheets at the University Teaching Hospital of Kigali in Rwanda in the most efficient and effective manner. To accomplish this goal, the research team reduced the time and devices needed to upload a surgical sheet by 78% and 50%, respectively. Hardware and software malfunctions were fixed, and the longevity of the system was improved as procedural checklists to upkeep and correctly utilize the system were implemented.