Automated feedback modestly improves perioperative treatment adherence of postoperative nausea and vomiting

J Clin Anesth. 2023 Jun;86:111081. doi: 10.1016/j.jclinane.2023.111081. Epub 2023 Feb 20.


Study objective: Extensive evidence demonstrates that medical record modernization and a vast amount of available data have not overcome the gap between recommended and delivered care. This study aimed to evaluate the use of clinical decision support (CDS) in conjunction with feedback (post-hoc reporting) to improve PONV medication administration compliance and postoperative nausea and vomiting (PONV) outcomes.

Design: Single center, prospective observational study between January 1, 2015, and June 30, 2017.

Setting: Perioperative care at a university-affiliated tertiary care center.

Patients: 57,401 adult patients who received general anesthesia in a non-emergency setting.

Intervention: A multi-phased intervention that consisted of post-hoc reporting for individual providers by email about PONV occurrences in their patients, followed by directive CDS through preoperative daily case emails that provided therapeutic PONV prophylaxis recommendations based on patients' PONV risk scores.

Measurement: Compliance with PONV medication recommendations, as well as hospital rates of PONV were measured.

Main result: Over the study period, there was a 5.5% (95% CI, 4.2% to 6.4%; p < 0.001) improvement in the compliance of PONV medication administration along with an 8.7% (95% CI, 7.1% to 10.2%, p < 0.001) reduction in PONV rescue medication administration in the PACU. However, there was no statistically or clinically significant reduction in the prevalence of PONV in the PACU. The prevalence of PONV rescue medication administration decreased during the Intervention Rollout Period (odds ratio 0.95 [per month]; 95% CI, 0.91 to 0.99; p = 0.017), and during the Feedback with CDS Recommendation Period (odds ratio, 0.96 [per month]; 95% CI, 0.94 to 0.99; p = 0.013).

Conclusion: PONV medication administration compliance modestly improves with CDS in conjunction with post-hoc reporting; however, no improvement in PACU rates of PONV occurred.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Anesthesia, General
  • Antiemetics* / therapeutic use
  • Feedback
  • Humans
  • Postoperative Nausea and Vomiting* / drug therapy
  • Postoperative Nausea and Vomiting* / epidemiology
  • Postoperative Nausea and Vomiting* / prevention & control
  • Risk Factors


  • Antiemetics