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Wacker J, Haller G, Hendrickx JFA, Ponschab M. A survey and analysis of peri-operative quality indicators promoted by National Societies of Anaesthesiologists in Europe: The EQUIP project. Eur J Anaesthesiol 2024:00003643-990000000-00219. [PMID: 39262333 DOI: 10.1097/eja.0000000000002054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
BACKGROUND To capture preventable peri-operative patient harm and guide improvement initiatives, many quality indicators (QIs) have been developed. Several National Anaesthesiologist Societies (NAS) in Europe have implemented quality indicators. To date, the definitions, validity and dissemination of such quality indicators, and their comparability with validated published indicators are unknown. OBJECTIVES The aim of this study was to identify all quality indicators promoted by NAS in Europe, to assess their characteristics and to compare them with published validated quality indicators. DESIGN A cross-sectional study with mixed methods analysis. Using a survey questionnaire, representatives of 37 NAS were asked if their society provided quality indicators to their members and, if so, to provide the list, definitions and details of quality indicators. Characteristics of reported quality indicators were analysed. SETTING The 37 NAS affiliated with the European Society of Anaesthesiology and Intensive Care (ESAIC) at the time. Data collection, translations: March 2018 to February 2020. PARTICIPANTS Representatives of all 37 NAS completed the survey. MAIN OUTCOME MEASURES QIs reported by NAS. RESULTS Only 12 (32%) of the 37 NAS had made a set of quality indicators available to their members. Data collection was mandatory in six (16.2%) of the 37 countries. We identified 163 individual quality indicators, which were most commonly descriptive (60.1%), anaesthesia-specific (50.3%) and related to intra-operative care (21.5%). They often measured structures (41.7%) and aspects of safety (35.6%), appropriateness (20.9%) and prevention (16.6%). Patient-centred care (3.7%) was not well covered. Only 11.7% of QIs corresponded to published validated or well established quality indicator sets. CONCLUSIONS Few NAS in Europe promoted peri-operative quality indicators. Most of them differed from published sets of validated indicators and were often related to the structural dimension of quality. There is a need to establish a European-wide comprehensive core set of usable and validated quality indicators to monitor the quality of peri-operative care. TRIAL REGISTRATION No registration.
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Affiliation(s)
- Johannes Wacker
- From the University of Zurich, Faculty of Medicine, Zurich, Switzerland (JW), Institute of Anesthesia and Intensive Care, Hirslanden Clinic, Zurich (JW), Department of Acute Care Medicine, Division of Anesthesiology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland (GH), Department of Epidemiology and Preventive Medicine, Health Services Management and Research Unit, Monash University, Melbourne, Victoria, Australia (GH), Department of Anesthesiology, Intensive Care and Pain Therapy, OLV Hospital, Aalst (JFAH), Department of Basic and Applied Medical Sciences, Ghent University, Ghent (JFAH), Department of Anesthesiology, UZLeuven, Leuven, Belgium & Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium (JFAH), Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna (MP), Department of Anesthesiology and Intensive Care, AUVA Trauma Hospital Linz, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria (MP)
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Ke JXC, de Vos M, Kojic K, Hwang M, Park J, Stuart H, Osborn J, Flexman A, Blake L, McIsaac DI. Healthcare delivery gaps in pain management within the first 3 months after discharge from inpatient noncardiac surgeries: a scoping review. Br J Anaesth 2023; 131:925-936. [PMID: 37716887 DOI: 10.1016/j.bja.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/11/2023] [Accepted: 08/02/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Poor pain control during the postoperative period has negative implications for recovery, and is a critical risk factor for development of persistent postsurgical pain. The aim of this scoping review is to identify gaps in healthcare delivery that patients undergoing inpatient noncardiac surgeries experience in pain management while recovering at home. METHODS Searches were conducted by a medical librarian in PubMed, MEDLINE, EMBASE, EBSCO CINAHL, Web of Science, and Cochrane Database of Systematic Reviews for articles published between 2016 and 2022. Inclusion criteria were adults (≥18 yr), English language, inpatient noncardiac surgery, and included at least one gap in care for acute and/or persistent pain management after surgery within the first 3 months of recovery at home. Two reviewers independently screened articles for inclusion and extracted data. Quotations from each article related to gaps in care were synthesised using thematic analysis. RESULTS There were 4794 results from databases and grey literature, of which 38 articles met inclusion criteria. From these, 23 gaps were extracted, encompassing all six domains of healthcare delivery (capacity, organisational structure, finances, patients, care processes and infrastructure, and culture). Identified gaps were synthesised into five overarching themes: education (22 studies), provision of continuity of care (21 studies), individualised management (10 studies), support for specific populations (11 studies), and research and knowledge translation (10 studies). CONCLUSIONS This scoping review identified health delivery gaps during a critical period in postoperative pain management. These gaps represent potential targets for quality improvement and future research to improve perioperative care and longer-term patient-centred outcomes. SCOPING REVIEW PROTOCOL Open Science Framework (https://osf.io/cq5m6/).
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Affiliation(s)
- Janny X C Ke
- Department of Anesthesia, Providence Health Care, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Maya de Vos
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Katarina Kojic
- Department of Anesthesia, Providence Health Care, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mark Hwang
- Undergraduate Medical Education Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason Park
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Heather Stuart
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Jill Osborn
- Department of Anesthesia, Providence Health Care, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alana Flexman
- Department of Anesthesia, Providence Health Care, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay Blake
- University of Arkansas for Medical Sciences Library, Little Rock, AK, USA
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
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Wacker J. Quality indicators for anesthesia and perioperative medicine. Curr Opin Anaesthesiol 2023; 36:208-215. [PMID: 36689392 PMCID: PMC9973445 DOI: 10.1097/aco.0000000000001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW Routine monitoring of care quality is fundamental considering the high reported rates of preventable perioperative morbidity and mortality. However, no set of valid and feasible quality indicators is available as the gold standard for comprehensive routine monitoring of the overall quality of perioperative care. The purpose of this review is to describe underlying difficulties, to summarize current trends and initiatives and to outline the perspectives in support of suitable perioperative quality indicators. RECENT FINDINGS Most perioperative quality indicators used in the clinical setting are based on low or no evidence. Evidence-based perioperative quality indicators validated for research purposes are not always applicable in routine care. Developing a core set of perioperative quality indicators for clinical practice may benefit from matching feasible routine indicators with evidence-based indicators validated for research, from evaluating additional new indicators, and from including patients' views. SUMMARY A core set of valid and feasible quality indicators is essential for monitoring perioperative care quality. The development of such a set may benefit from matching evidence-based indicators with feasible standard indicators and from including patients' views.
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Affiliation(s)
- Johannes Wacker
- Institute of Anaesthesia and Intensive Care, Hirslanden Clinic
- University of Zurich, Faculty of Medicine, Zurich, Switzerland
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Chen X, Zhang J, Yu Y, Wang H, Ma G, Wang D, Cao H, Yang J. Ultrasound-Triggered on Demand Lidocaine Release Relieves Postoperative Pain. Front Bioeng Biotechnol 2022; 10:925047. [PMID: 35898649 PMCID: PMC9310090 DOI: 10.3389/fbioe.2022.925047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Safe and non-invasive on-demand relief is a crucial and effective treatment for postoperative pain because it considers variable timing and intensity of anesthetics. Ultrasound modulation is a promising technique for this treatment because it allows convenient timed and non-invasive controlled drug release. Here, we created an ultrasound-triggered lidocaine (Lido) release platform using an amino acid hydrogel functioning as three-dimensional (3D) scaffold material (Lido-PPIX@ER hydrogel). It allows control of the timing, intensity and duration of lidocaine (Lido) to relieve postoperative pain. The hydrogel releases Lido due to the elevated reactive oxygen species (ROS) levels generated by PPIX under ultrasound triggering. The Lido-PPIX@ER hydrogel under individualized ultrasound triggering released lidocaine and provided effective analgesia for more than 72 h. The withdrawal threshold was higher than that in the control group at all time points measured. The hydrogel showed repeatable and adjustable ultrasound-triggered nerve blocks in vivo, the duration of which depended on the extent and intensity of insonation. On histopathology, no systemic effect or tissue reaction was observed in the ultrasound-triggered Lido-PPIX@ER hydrogel-treated group. The Lido-PPIX@ER hydrogel with individualized (highly variable) ultrasound triggering is a convenient and effective method that offers timed and spatiotemporally controlled Lido release to manage postoperative pain. This article presents the delivery system for a new effective strategy to reduce pain, remotely control pain, and offer timed and spatiotemporally controlled release of Lido to manage postoperative pain.
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Affiliation(s)
- Xiaohong Chen
- The Frist Affiliated Hospital of Soochow University, Suzhou, China
- Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Jianfeng Zhang
- Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Yan Yu
- Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Haoran Wang
- Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Genshan Ma
- Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Di Wang
- Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Hanzhong Cao
- Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Jianping Yang
- The Frist Affiliated Hospital of Soochow University, Suzhou, China
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