Anceaux, Françoise <br/><br/>
La consultation préopératoire en anesthésie : gestion de la prise d'informations et rôle des données retenues dans la planification du processus d'anesthésie 

 -  2002.<br/>							 
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<br/><br/> RÉSUMÉ L’article porte sur l’activité de collecte des informations pertinentes développées par les anesthésistes lors de la consultation préopératoire. Il présente une analyse de cette activité en situation naturelle effectuée à partir, d’une part, des contenus de fiches d’anesthésie et, d’autre part, de l’enregistrement de consultations. Une seconde analyse comparative de la prise d’informations avec deux types de support, le support “ papier ” habituel et un support informatisé, est ensuite rapportée. Les analyses mettent en évidence l’existence d’une alternance de trois stratégies de gestion de prise d’informations ainsi que les caractéristiques et le rôle des informations retenues dans la planification de l’intervention ultérieure.  ANESTHETIC PREOPERATIVE CONSULTATION : INFORMATION GATHERING MANAGEMENT AND ROLE OF THE DATA SELECTED ON ANESTHESIA PROCESS PLANNING Anesthesia is a highly dynamic process, characterized by some specific features such as uncertainty, high speed, time pressure, vital risks (the patient’s life is at stake). Moreover, in the anesthetic process, the conditions change rapidly and the task is frequently interrupted. Several studies (Gaba, 1994 ; Xiao, Milgram, &amp; Doyle, 1997a, b) have demonstrated the importance of preoperative preparation tasks. In the present study, we focused on preliminary planning activities by studying the strategies for information gathering and the notation of the selected data. The anesthetists’major aim during this preoperative phase is to assess the risks of the anesthesia for the patient and to anticipate for potential problems. During the consultation, the anesthetists exhaustively scan the patient’s medical framework via the medical interview and the clinical examination, and the data collected are written down on a one-page paper sheet, which is part of the anesthetic record. According to French new legal recommendations, this anesthetic record should be typewritten. To deal with this requirement, several types of software have been developed to handle medical information gathering and recording during the preoperative phase. We used such a prototype, named Anesthesia Mobile System (AMS). We then compared the anesthetists’strategies for collecting relevant medical information in the two situations : one-page paper sheet and AMS. All the consultations were videotaped and we performed autofacing interviews. We recorded the duration of the consultations, the fields and domains investigated and completed, the data collected and recorded, the type of notation used. We then described the patient/anesthetist dialogs via diagrams connecting the anesthetists’ questions, the patients’answers and the resulting recorded data. The results suggest that the anesthetists can use three strategies to gather information : (i) they can question the patient following the standard order set by the paper file ; (ii) from an information given by the patient, they can identify some significant pattern and rely on this inference to seek further specific information, and (iii) sometimes, they allow the patient to “ tell his/her story ”. The anesthetists can alternate those strategies during the consultation, each one weighing more or less depending on the complexity of the medical case. The mixed utilization of these three strategies plays one main function : It allows the anesthetists to elaborate a proper representation of the medical case, via an “ opportunistic ” information gathering. Among the information provided by the patients, the anesthetists select relevant data allowing them to characterize and categorize the medical case and to ground the decision for the anesthesia itself. The recorded data can be either raw information or interpreted items which contain elements for planning the anesthetic process and information allowing the assessment of the plan and its adjustment during the surgery, according to the patient’s physiological status. The comparison of data gathering and recording with the paper file and with the computer shows important differences : With the computerized record, the consultation lasts six times longer, more data are recorded but some of these data are less relevant and, conversely, some essential data are not present. Due to some characteristics of the AMS’ interface, the alternation of strategies for information gathering becomes impossible, and the users are constrained to adopt the systematic order set by the interface, which is close to the structure of the paper sheet. This constraint stiffens the dialog patient/anesthetist, that becomes very formal, and interferes with the elaboration of the representation of the medical case. This negative interference is reinforced by the fact that the anesthetists cannot have before their eyes all the information already recorded while they go on with the medical interview. The results are discussed and particularly for their implications on the specification of software to handle medical information gathering.