Intervention
INTERACTIONS
The ACT is a remote suite staffed by an anesthesiologist who is supported by a study coordinator trained in the study procedures, the decision support software interface, and communication tools. A total of 1 to 3 personnel, including nurse anesthetists, anesthesiology resident physicians, and nurse anesthetist trainees, also participated daily. The suite computers accessed the EHR and a customized version of the decision support platform. Although the protocol envisioned live waveform display and audio-video monitoring of ORs, these technological features were not available.Descriptions of how the ACT interface was developed and adapted to clinician feedback to improve acceptability and usability have been published previously.Interactions between the ACT and OR clinicians evolved during the study.After the Epic EHR implementation (June 2018), the Epic In Basket messaging system was used for case reviews and nonurgent alerts. Phone calls were used for time-sensitive alerts. Clinicians in the ACT were encouraged to log OR communications and case reviews in the decision support software and to select an action or reason for silencing each alert. In the log, ACT staff rated the importance (referred to as 