Automated alerts and intraoperative noninvasive blood pressure monitoring gaps: a retrospective before-and-after study

Intraoperative noninvasive blood pressure (NIBP) monitoring is recommended at least every 5 min during anesthesia, yet prolonged gaps between documented measurements still occur in routine practice. These gaps may reflect workflow interruptions, device-related factors, or failure to recognize outdated displayed values. We evaluated whether implementation of a vendor-embedded NIBP measurement gap alert was associated with fewer prolonged intraoperative NIBP monitoring gaps.

We conducted a single-center, retrospective before-and-after study using anesthesia information management system data from January 1, 2018, to December 31, 2024. A vendor-embedded on-screen alert was implemented on February 24, 2021, and was triggered when no NIBP value had been charted for ≥ 5 min. Eligible cases were anesthesiology-managed surgical cases without arterial catheter monitoring or continuous non-invasive finger-cuff monitoring. The primary outcome was the case-level occurrence of at least one ≥ 10-minute NIBP measurement gap (gap10). Secondary outcomes were the maximum NIBP measurement interval per case (gaptime) and the occurrence of a ≥ 20% systolic blood pressure (SBP) change across the maximum NIBP measurement interval. Multivariable models adjusted for prespecified case-mix covariates and calendar time.

The analytic cohort included 34,233 cases, comprising 15,186 pre-alert and 19,047 post-alert cases. Gap10 occurred in 1,890 cases (5.52%): 1,014 of 15,186 (6.68%) in the pre-alert period and 876 of 19,047 (4.60%) in the post-alert period. In adjusted logistic regression, the post-alert period was associated with lower odds of gap10 than the pre-alert period (odds ratio [OR], 0.673; 95% confidence interval [CI], 0.499–0.906). In an adjusted Gamma model with a log link, the post-alert period was associated with a shorter expected gaptime (expected ratio, 0.951; 95% CI, 0.923–0.980). The post-alert period was also associated with lower odds of a ≥ 20% SBP change across the maximum NIBP measurement interval (OR, 0.796; 95% CI, 0.699–0.907).

Among anesthetic cases without arterial catheter monitoring or continuous non-invasive finger-cuff monitoring, the alert was associated with fewer ≥ 10-min gaps, shorter maximum NIBP intervals, and lower odds of a ≥ 20% SBP change across the maximum NIBP interval.