πŸ’¬ EHR Alerts

Perioperative workflows and best practice advisories

EHR Workflow Modules β€” educational perioperative EHR workflow examples.

Note

These best practice advisory (BPA) alerts are part of a specific electronic health record rollout at Harborview Medical Center (University of Washington), implemented in an attempt to improve situational awareness and standardize practice around ICP monitoring during transport and in the operating room. Outcomes data from this rollout are unpublished. Screenshots reflect real, in-use alerts rather than hypothetical mockups; other institutions should adapt the underlying workflow to their own EHR system and policies.

🧠 Identify Patients
EVD and ICP monitor identification πŸ” Data Review
Information to abstract preoperatively πŸ“‹ Documentation
Structured perioperative documentation

Identify Patients

EVD and ICP monitor identification workflows

This EHR alert is part of a Harborview Medical Center initiative intended to improve identification of patients with EVDs and intracranial monitoring devices, and to enhance perioperative communication and documentation consistency (unpublished data).

Alerts may appear during perioperative workflow review, ICU handoff, transport preparation, or operating room scheduling workflows.

TipExample EHR Alert

Example EHR alert identifying patients with:

  • External ventricular drains
  • ICP monitors
  • Brain tissue oxygen monitors

Example screenshot of an EHR best practice advisory identifying a patient with an EVD and intracranial monitoring devices.

Example screenshot of an EHR best practice advisory identifying a patient with an EVD and intracranial monitoring devices.

Source: Dr. Abhijit V. Lele, University of Washington.

Preoperative Review

Suggested perioperative information abstraction

Suggested perioperative information to review:

  • ICP trends
  • CSF drainage trends
  • Clamp intolerance
  • Physiological targets
  • Neurosurgery contact information
  • Hyperosmolar therapy
  • Sedation requirements

The goal is to improve perioperative situational awareness before transport or operating room transfer.

Example EHR perioperative workflow screen displaying ICP trends, CSF output, and transport readiness documentation.

Example EHR perioperative workflow screen displaying ICP trends, CSF output, and transport readiness documentation.

Source: Dr. Abhijit V. Lele, University of Washington.

Clinical Pearls

  • Review clamp intolerance before transport.
  • Confirm physiologic targets with ICU and neurosurgery.
  • Review hyperosmolar therapy requirements.
  • Assess recent ICP trends before OR transfer.
  • Ensure multidisciplinary communication.

This module is intended for educational and workflow awareness purposes only. Screenshots reflect real, active BPA alerts at the University of Washington and should be adapted to each institution’s own EHR system, policies, and clinical workflows.

OR Documentation

Structured perioperative documentation workflows

Suggested perioperative documentation elements:

  • EVD setting (clamp/open status)
  • ICP mmHg
  • CPP mmHg
  • CSF color
  • CSF output

This structured documentation workflow is part of the same Harborview Medical Center initiative, intended to improve communication across ICU, transport, anesthesia, and neurosurgical teams (unpublished data).

Example intraoperative EHR documentation workflow showing EVD status, ICP documentation, and perioperative communication fields.

Example intraoperative EHR documentation workflow showing EVD status, ICP documentation, and perioperative communication fields.

Source: Dr. Abhijit V. Lele, University of Washington.