Smart Anesthesia Manager™ - SAM
Adding Intelligence to Anesthesia Information Management Systems
What is SAM?
SAM (Smart Anesthesia Manager™) is a software package developed by University of
Washington that works in parallel with an Anesthesia Information Management System
(AIMS). The primary function of SAM is to provide real-time decision support and
guidance to anesthesia providers. It obtains near real-time data from AIMS and finds
issues related to quality of care, patient safety, billing and compliance. Ongoing issues are
notified to the anesthesia providers with directions to resolve them. The notification is
either in the form of “pop-up” messages overlaid on top on the AIMS screen or text
pages. Additionally, SAM provides point of care tools to determine the correct billing
codes, provide barcode confirmation of medications and facilitate safe patient handoff.
 Installed in 3 large hospitals
- University of Washington Medical Center
- Harborview Medical Center
- Ochsner Medical Center (discontinued after EPIC migration)
- Northwest Medical Center (planned)
 In continuous operation for over 5 years at University of Washington
Medical and Harborview Medical Centers
 Software solution with no additional computer hardware required
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Why real-time decision support?
During a surgical procedure, an anesthesia provider performs the important tasks of keeping the patient safely
anesthetized and physiologically stable. This involves concurrent real-time interpretation and execution of several
steps in parallel, including adequately maintaining physiological parameters, ventilating the patient, administering
anesthetic drugs and maintaining fluid balance –all in response to anesthesia (physiological changes), ongoing
surgery (blood loss) and patient responses (heart function). To execute these simultaneous steps, the anesthesia
provider has to efficiently and effectively capture and disseminate information from multiple devices and systems,
and make rapid decisions and interventions that are based on best practice and evidence. In addition, the
anesthesia provider also keeps documentation of patient care steps in an anesthesia record, which serves as the
primary medical legal and billing document for anesthesia care. Due to the complexity of anesthesia care and the
rapid-pace in an operating room, oversights and errors, such as delayed (or even missed) administration of
needed medication or delayed correction of anesthesia problems, are not infrequent.
Real-time detection and notification of clinical issues has been shown to be highly effective in improving patient
safety, quality of care, revenue capture and waste reduction by University of Washington and several other
institutions. Real-time decision support significantly improves vigilance of the anesthesia provider in a high data
velocity environment (Operating room) prone to multiple distractions.
Highlights:
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Real-time decision support system for the operating room
>99% compliant SCIP (Surgical Care Improvement Project—The Joint Commission) measures (Antibiotic
delivery, β-blocker management)
Near 100% revenue capture related to Invasive lines and 1-lung ventilation
Near 100% CMS (Medicare) compliance by ensuring complete and correct documentation
Improved patient safety
- reduced gaps in BP monitoring,
- fewer unsafe hypo and hypertension events,
- voice confirmation of medication administration
Improved adherence to institutional protocols:
Glucose management (improvement by 100%),
- Traumatic Brain Injury Care
- Postoperative Nausea & Vomiting prophylaxis (in development)
Reduced wastage of inhalational agents through lower Fresh Gas Flow (~ 30% reduction)
Barcode confirmation of medication delivery
Hand off tool for safe patient transfer between providers
Framework for implementing, following and auditing checklists
Coding utility to find Anesthesia Crosswalk codes with the best RVU
Communication tool
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Improvements with SAM seen at UW Medical Center:
Return on investment: $1 Million per 10,000 cases
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Example SAM features:
Decision Support tool
Guidance reminders related to
protocols and detected issues related
to clinical care, billing, compliance and
medication utilization are brought to
the attention of the anesthesia
provider via “pop-up” screens and text
Glucose management tool
pages
Decision support to aid anesthesia
provider follow institutional glucose
management protocol.
Anesthesia crosswalk Search Tool
Easy to use coding tool to determine
Anesthesia Crosswalk Code with optimal
RVU
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Voice confirmation of bar-coded drug delivery
Barcode and voice confirmation of
medications syringes prior to
administration
Handoff tool
Patient handoff tool for safe and
effective transfer of care between
anesthesia and nursing teams
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Comparison of SAM and AIMS Decision Support features
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Grant Support:
Ongoing Research Support:
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Coulter Foundation, Evaluation of Smart Anesthesia Manager™ (SAM) Integrated with Multiple Anesthesia
Information Systems to Deliver Real-time Decision Support and Guidance.
- Integration of SAM with two additional Anesthesia systems
- PI: Bala G. Nair, PhD
NIH /R01 NS072308-01 Implementation Science to Increase Use of Evidence Based Pediatric Brain Injury
Guidelines.
- Support for development and implementation of decision support and guidance in SAM
for traumatic brain injury protocol
- PI: Monica Vavilala, MD
Anesthesia Patient Safety Foundation (APSF), “Study of the Implementation and Performance of the APSF
Pre-Anesthetic Induction Patient Safety (PIPS) Checklist”
- Support for development and implementation of checklists in SAM
- PI: T. Andrew Bowdle, MD, PhD
Completed Research Support
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Laura Cheney Patient Safety Award, University of Washington, “Improving patient safety with SAM”
- Development of blood pressure management decision support in SAM
- PI: Bala G. Nair, PhD
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Technology Gap Innovation Fund (TGIF), UW Technologies, “Smart Anesthesia Messenger (SAM)”
- Development of rules builder engine in SAM
- PI: Bala G. Nair, PhD
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Patient Safety Innovation Fund (PSIP), UW Medicine, “Improving Intraoperative Glycemic Control Using a
Real-time Decision Support System”,
- Development of decision support for glucose management in SAM
- PI: Bala G. Nair, PhD
Copyright © 2009-2015 University of Washington, All rights reserved.
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Manuscripts:
[1] Nair B, Grunzweig K, Peterson GN, Horibe M, Neradilek MB, Newman S, Van Norman G, Schwid HA, Hao W, Hirsch IB,
Dellinger PE; Intraoperative Blood Glucose Management: Impact of a Real-Time Decision Support System on Adherence
to Institutional Protocol. 2014 (pub ahead of print J Clin Monit Comput). Impact Factor: 1.7
[2] Jelacic S, Bowdle A, Nair BG, Kusulos D, Bower L, Togashi K; A Safety System for Anesthesia Drug Administration Using
Barcode Technology: The Codonics Safe Label System and Smart Anesthesia Manager. Anesthesia & Analgesia
121(2):410-21; 2015. Impact Factor: 3.1
[3] Nair BG, Horibe M, Newman S, Wu W, Peterson GN, Schwid HA. AIMS-based Near Real-time Decision Support to Manage
Intraoperative Hypotension and Hypertension. Anesth Analg 118(1):206-14; 2014. Impact Factor: 3.1
[4] Nair BG, Horibe M, Newman S, Wu W, Schwid HA; Near Real-time Notification of Gaps in Cuff Blood Pressure Recordings
for Improved Patient Monitoring. J Clin Monit Comput. 27(3):265-71; 2013. Impact Factor: 1.7
[5] Nair BG, Peterson GN, Neradilek MB, Newman SF, Huang EY, Schwid HA. Reducing Wastage of Inhalation Anesthetics
using Real-time Decision Support to Notify of Excessive Fresh Gas Flow. Anesthesiology 118(4):874-84; 2013. Impact
Factor: 5.4
[6] Nair BG, Newman SF, Peterson GN, Schwid HA; Smart Anesthesia Manager™ - A Real-time Decision Support System for
Anesthesia Care during Surgery. IEEE Trans Biomed Eng. 60(1):207-10; 20132012. Impact Factor: 2.3
[7] Nair BG, Peterson GN, Newman S, Wu W, Schwid HA; Improved Documentation of β-blocker Quality
Measure through Anesthesia Information Management System and Real-time Notification of
Documentation Errors. Jt Comm J Qual Patient Saf. 38(6):283-8; 2012. Impact Factor: 2.4
[8] Nair BG, Newman SF, Peterson GN, Schwid HA; Automated electronic reminders to improve redosing
of antibiotics during surgical cases: comparison of two approaches. Surg Infect; 12(1):57-63; 2011. Impact Factor: 1.8
[9] Nair BG, Newman S, Peterson GN, Wu W, Schwid HA; Feedback Mechanisms Including Real-Time
Electronic Alerts to Achieve Near 100% Timely Prophylactic Antibiotic Administration in Surgical Cases. Anesthesia &
Analgesia; 111(5):1293-1300; 2010. Impact Factor: 3.1
News articles:
[1] UW Medicine Magazine: Laura Cheney Patient Safety Award
http://depts.washington.edu/meddev/uwmedmagazine/archives/vol33-no1/report-to-donors/laura-cheneyprofessorship.php
[2] Anesthesiology News (National Magazine, February 2011)
http://www.anesthesiologynews.com/ViewArticle.aspx?d=Technology&d_id=8&i=February%2B2011&i_id=702&a_i
d=16607
[3] Anesthesiology News (National Magazine, May 2015)
http://anesthesiologynews.com/ViewArticle.aspx?d=Technology&d_id=8&i=May+2015&i_id=1183&a_id=32357
[4] Anesthesiology News (National Magazine, June 2015)
Abstracts and Presentations:
[1] Development and Use of Smart Anesthesia Manager, An AIMS Based Real-Time Decision Support Module. Oral
Presentation (invited). Society for Technology in Anesthesia Annual Meeting 2015. Phoenix, AZ
[2] Evaluation Of A Decision Support System To Improve Timely Perioperative Antibiotic Redosing And Charge Capture Of
Invasive Line Placements. International Anesthesia Research Society Annual Meeting 2014. Poster presentation.
Montréal, Canada
[3] Smart Anesthesia Monitor- A Real Time Rules Based Decision Support Tool for Anesthesia and Surgical Care.
UHC Annual Meeting 2013, Oral presentation (invited), Atlanta, GA
[4] Smart Anesthesia Manager™. Real-time Decision Support: Bala G. Nair Ph.D (International Conference on Anesthesia &
Perioperative Care, San Antonio, TX, Oral Presentation, 2012)
[5] Improved Patient Monitoring through Real-time Notification of Gaps in Cuff Blood Pressure Recordings: Bala G. Nair
Ph.D, Shu-Fang Newman, M.S., Howard A. Schwid, M.D. (American Society of Anesthesiologists, Oral Presentation 2011)
[6] Wastage Reduction of Inhalation Agents through Real-time Notification of Excess Fresh Gas Flow Bala G. Nair Ph.D, Gene
N. Peterson, M.D., Ph.D., Shu-Fang Newman, M.S., Howard A. Schwid, M.D. (American Society of Anesthesiologists,
Poster Presentation 2011)
[7] Improved billing of invasive line procedures through real-time notification of documentation errors: Bala G. Nair Ph.D,
Shu-Fang Newman, M.S., Howard A. Schwid, M.D. (American Society of Anesthesiologists, Oral Presentation 2010)
Copyright © 2009-2015 University of Washington, All rights reserved.
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