# TECTONICS (Telemedicine Control Tower for the OR: Navigating Information, Care and Safety) trial

> **NIH NIH R01** · WASHINGTON UNIVERSITY · 2021 · $645,032

## Abstract

Abstract
Adverse outcomes, including death, respiratory failure and renal failure, are common after surgery, and
represent a serious public health challenge. Such adverse outcomes can be mitigated through integrated,
collaborative health information technology solutions that provide clinicians cognitive and computational
support. The chief motivation for the TECTONICS (Telemedicine Control Tower for the OR: Navigating
Information, Care and Safety) trial is that a multi-faceted telemedicine solution has the potential to facilitate the
dynamic assessment of risk, diagnose negative patient trajectories, and implement evidence-based practices.
The net result for patients would be improved safety and outcomes. Our telemedicine solution, called the
Anesthesiology Control Tower (ACT), encompasses real-time patient data integration from the electronic
health record, clinician decision support, machine learning algorithms that predict adverse outcomes, and
remote monitoring for the operating room (OR). This conceptualization of sophisticated remote monitoring for
the OR is somewhat analogous to an air traffic control tower for a busy airport. The innovative TECTONICS
trial will build on a series of preliminary studies (funded by the Agency for Healthcare Research and Quality,
and the National Science Foundation) that have (i) established the usefulness and usability of a prototype
telemedicine ACT; (ii) customized and enhanced decision-support alerts for the ACT, based on clinician user
feedback; (iii) designed, developed, and tested machine learning algorithms that predict adverse postoperative
outcomes; and (iv) established the feasibility of conducing a real-world randomized trial of the prototype ACT.
The TECTONICS trial builds logically on these preliminary studies. Aim 1 is to show that we can implement
and sustain an integrated ACT system. As part of this, we will iteratively assess the accuracy of our machine
learning algorithms and modify them to improve their ability to predict in real time when patients are at high risk
for experiencing negative outcomes. Aim 2 is to understand how the ACT system affects clinicians’
(anesthesiologists and certified registered nurse anesthetists [CRNAs]) thinking, decision-making and behavior.
This understanding will help us to enhance the ACT system, improve workflow processes in the ACT and in the
OR, and improve collaborative interactions between anesthesiologists and CRNAs. Aim 3 is to conduct a
rigorous clinical trial. We will evaluate the impact of the ACT system on the quality of care in the OR, and
clinical outcomes such as intraoperative awareness, and postoperative delirium, renal failure, respiratory
failure, and 30-day mortality. TECTONICS will be the first practical and scientifically rigorous trial of a
telemedicine solution for the operating room, and will inform the usefulness of incorporating such technology in
routine care of surgical patients, including under-resourced healthcare settings. Wit...

## Key facts

- **NIH application ID:** 10120737
- **Project number:** 5R01NR017916-03
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Michael Simon Avidan
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $645,032
- **Award type:** 5
- **Project period:** 2019-05-15 → 2024-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10120737

## Citation

> US National Institutes of Health, RePORTER application 10120737, TECTONICS (Telemedicine Control Tower for the OR: Navigating Information, Care and Safety) trial (5R01NR017916-03). Retrieved via AI Analytics 2026-06-11 from https://api.ai-analytics.org/grant/nih/10120737. Licensed CC0.

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