In clinical practice (and by that I mean hands-on care), there can be a conflict between doing the task, e.g. putting a patient to sleep, and recording what you’re doing. Sometimes, the record can be done retrospectively. Surgeons, for example, do the operation and then write up what they’ve done. Anaesthetists, in contrast, divide their attention between looking after the unconscious patient and recording their activity in ‘real’ time. This is always a source of stress for the anaesthetist as it involves juggling the urgent versus the important. In the old days, i.e. when I started 20 years’ ago, there was no contemporaneous recording, rather, like the surgeon, you simply wrote down what you’d done afterwards. No need for recording the vital signs, and machine status every 5 minutes. However, the norm nowadays is to record more and more data items, more or less simultaneously.
Theoretically, some of the recording can be captured automatically, e.g. the output from monitors and machines. However, in reality this is rarely done as it requires ‘interpretation’ by the anaesthetist. For example, if your ECG lead becomes disconnected for a few seconds, a ‘flat line’ is produced. Clearly, the patient has not died, but how does the ‘dumb’ monitor now that? Hence, most anaesthetists prefer to record patient and anaesthetic machine information manually, and slightly retrospectively, so that unimportant anomalies can be ironed out.
At present, we note down on paper with a pen, the blood pressure, heart rate, oxygen saturation, end-tidal CO2, etc, etc, every few minutes. In addition, a record of drugs given, timings, doses, intravenous fluids, etc is kept. It would be very difficult to do this electronically if it meant keying-in data and using a mouse; your attention just wouldn’t be where it should be – on the patient.
But, a mobile touchscreen, that you can pick up and put down, allows you to replicate what you’re currently doing manually, only better, quicker and more accurately. What’s more, and most important, is that it can all be done, ‘in the line of sight’ of the patient. There are other benefits too. Legibility and data handling afterwards are much easier. And, as is becoming mandatory, anaesthetists can have a digital record of all their activity, so productivity and experience can be logged.
So, no more conflict between competing tasks. The patient can sleep safely with their anaesthetist watching over them!
What about the future? Perhaps the ultimate ‘black box’ recording is real-time video. Several surveillance cameras positioned in the Operating Theatre could record everything that’s going on (even a ‘head-cam’ for the staff?). This, combined with outputs from monitors and machines, would provide a near incontrovertible record of proceedings, and remove the need for any other form of recording, allowing the staff to concentrate on their primary task of caring for the patient. You can imagine what could be done with such videos!