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Wagstaff D, Warnakulasuriya S, Singleton G, Moonesinghe SR, Fulop N, Vindrola-Padros C. A scoping review of local quality improvement using data from UK perioperative National Clinical Audits. Perioper Med (Lond) 2022; 11:43. [PMID: 36031654 PMCID: PMC9422140 DOI: 10.1186/s13741-022-00273-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 06/22/2022] [Indexed: 11/28/2022] Open
Abstract
Background Significant resources are invested in the UK to collect data for National Clinical Audits (NCAs), but it is unclear whether and how they facilitate local quality improvement (QI). The perioperative setting is a unique context for QI due to its multidisciplinary nature and history of measurement. It is unclear which NCAs evaluate perioperative care, to what extent their data have been used for QI, and which factors influence this usage. Methods NCAs were identified from the directories held by Healthcare Quality Improvement Partnership (HQIP), Scottish Healthcare Audits and the Welsh National Clinical Audit and Outcome Review Advisory Committee. QI reports were identified by the following: systematically searching MEDLINE, CINAHL Plus, Web of Science, Embase, Google Scholar and HMIC up to December 2019, hand-searching grey literature and consulting relevant stakeholders. We charted features describing both the NCAs and the QI reports and summarised quantitative data using descriptive statistics and qualitative themes using framework analysis. Results We identified 36 perioperative NCAs in the UK and 209 reports of local QI which used data from 19 (73%) of these NCAs. Six (17%) NCAs contributed 185 (89%) of these reports. Only one NCA had a registry of local QI projects. The QI reports were mostly brief, unstructured, often published by NCAs themselves and likely subject to significant reporting bias. Factors reported to influence local QI included the following: perceived data validity, measurement of clinical processes as well as outcomes, timely feedback, financial incentives, sharing of best practice, local improvement capabilities and time constraints of clinicians. Conclusions There is limited public reporting of UK perioperative NCA data for local QI, despite evidence of improvement of most NCA metrics at the national level. It is therefore unclear how these improvements are being made, and it is likely that opportunities are being missed to share learning between local sites. We make recommendations for how NCAs could better support the conduct, evaluation and reporting of local QI and suggest topics which future research should investigate. Trial registration The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42018092993). Supplementary Information The online version contains supplementary material available at 10.1186/s13741-022-00273-0.
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Moonesinghe SR, McGuckin D, Martin P, Bedford J, Wagstaff D, Gilhooly D, Santos C, Wilson J, Dorey J, Leeman I, Smith H, Vindrola-Padros C, Edwards K, Singleton G, Swart M, Baumber R, Sahni A, Warnakulasuriya S, Vohra R, Ellicott H, Bougeard AM, Chazapis M, Ignacka A, Cripps M, Brent A, Drake S, Goodwin J, Martinez D, Williams K, Singh P, Bedford M, Vallance AE, Samuel K, Lourtie J, Olive D, Taylor C, Tucker O, Aresu G, Swift A, Fulop N, Grocott M. The Perioperative Quality Improvement Programme (PQIP patient study): protocol for a UK multicentre, prospective cohort study to measure quality of care and outcomes after major surgery. Perioper Med (Lond) 2022; 11:37. [PMID: 35941603 PMCID: PMC9361526 DOI: 10.1186/s13741-022-00262-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 04/28/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Major surgery accounts for a substantial proportion of health service activity, due not only to the primary procedure, but the longer-term health implications of poor short-term outcome. Data from small studies or from outside the UK indicate that rates of complications and failure to rescue vary between hospitals, as does compliance with best practice processes. Within the UK, there is currently no system for monitoring postoperative complications (other than short-term mortality) in major non-cardiac surgery. Further, there is variation between national audit programmes, in the emphasis placed on quality assurance versus quality improvement, and therefore the principles of measurement and reporting which are used to design such programmes. Methods and analysis The PQIP patient study is a multi-centre prospective cohort study which recruits patients undergoing major surgery. Patient provide informed consent and contribute baseline and outcome data from their perspective using a suite of patient-reported outcome tools. Research and clinical staff complete data on patient risk factors and outcomes in-hospital, including two measures of complications. Longer-term outcome data are collected through patient feedback and linkage to national administrative datasets (mortality and readmissions). As well as providing a uniquely granular dataset for research, PQIP provides feedback to participating sites on their compliance with evidence-based processes and their patients’ outcomes, with the aim of supporting local quality improvement. Ethics and dissemination Ethical approval has been granted by the Health Research Authority in the UK. Dissemination of interim findings (non-inferential) will form a part of the improvement methodology and will be provided to participating centres at regular intervals, including near-real time feedback of key process measures. Inferential analyses will be published in the peer-reviewed literature, supported by a comprehensive multi-modal communications strategy including to patients, policy makers and academic audiences as well as clinicians.
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Affiliation(s)
- S Ramani Moonesinghe
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK. .,Health Services Research Centre, Royal College of Anaesthetists, London, UK. .,Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Dermot McGuckin
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK
| | - Peter Martin
- Department for Applied Health Research, UCL, London, UK
| | - James Bedford
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK.,Health Services Research Centre, Royal College of Anaesthetists, London, UK.,Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Duncan Wagstaff
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK.,Health Services Research Centre, Royal College of Anaesthetists, London, UK.,Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Gilhooly
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK.,Health Services Research Centre, Royal College of Anaesthetists, London, UK.,Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Cristel Santos
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Jonathan Wilson
- Department of Anaesthesia, York Teaching Hospitals NHS Foundation Trust, York, UK
| | | | | | - Helena Smith
- Department of Anaesthesia, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Cecilia Vindrola-Padros
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK.,Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Kylie Edwards
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Georgina Singleton
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Michael Swart
- Department of Anaesthesia, Torbay Hospital, Torquay, UK
| | - Rachel Baumber
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL, London, UK.,Department of Anaesthesia, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Arun Sahni
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Samantha Warnakulasuriya
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ravi Vohra
- Department of Upper GI Surgery, Nottingham University Hospitals, Nottingham, UK
| | - Helen Ellicott
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | | | - Maria Chazapis
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aleksandra Ignacka
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Alexandra Brent
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | | | | | - Dorian Martinez
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Karen Williams
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Pritam Singh
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Bedford
- Department of Colorectal Surgery, Birmingham Heartlands Hospital, Birmingham, UK
| | | | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Foundation Trust , Bristol, UK
| | - Jose Lourtie
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Dominic Olive
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Christine Taylor
- Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | - Olga Tucker
- Department of Upper Gastrointestinal Surgery, Heartlands Hospital, Birmingham, UK
| | - Giuseppe Aresu
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | | | - Naomi Fulop
- Department for Applied Health Research, UCL, London, UK
| | - Mike Grocott
- Division of Critical Care, University of Southampton, Southampton, UK
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Barratt H, Hutchings A, Pizzo E, Aspinal F, Jasim S, Gafoor R, Ledger J, Mehta R, Mason J, Martin P, Fulop NJ, Morris S, Raine R. Mixed methods evaluation of the Getting it Right First Time programme in elective orthopaedic surgery in England: an analysis from the National Joint Registry and Hospital Episode Statistics. BMJ Open 2022; 12:e058316. [PMID: 35710256 PMCID: PMC9207914 DOI: 10.1136/bmjopen-2021-058316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the impact of the 'Getting it Right First Time' (GIRFT) national improvement programme in orthopaedics, which started in 2012. DESIGN Mixed-methods study comprising statistical analysis of linked national datasets (National Joint Registry; Hospital Episode Statistics; Patient-Reported Outcomes); economic analysis and qualitative case studies in six National Health Service (NHS) Trusts. SETTING NHS elective orthopaedic surgery in England. PARTICIPANTS 736 088 patients who underwent primary hip or knee replacement at 126 NHS Trusts between 1 April 2009 and 31 March 2018, plus 50 NHS staff. INTERVENTION Improvement bundle including 'deep dive' visits by senior clinician to NHS Trusts, informed by bespoke set of routine performance data, to discuss how improvements could be made locally. MAIN OUTCOME MEASURES Number of procedures conducted by low volume surgeons; use of uncemented hip implants in patients >65; arthroscopy in year prior to knee replacement; hospital length of stay; emergency readmissions within 30 days; revision surgery within 1 year; health-related quality of life and functional status. RESULTS National trends demonstrated substantial improvements beginning prior to GIRFT. Between 2012 and 2018, there were reductions in procedures by low volume surgeons (ORs (95% CI) hips 0.58 (0.53 to 0.63), knees 0.77 (0.72 to 0.83)); uncemented hip prostheses in >65 s (OR 0.56 (0.51 to 0.61)); knee arthroscopies before surgery (OR 0.48 (0.41 to 0.56)) and mean length of stay (hips -0.90 (-1.00 to -0.81), knees -0.74 days (-0.82 to -0.66)). The additional impact of visits was mixed and comprised an overall economic saving of £431 848 between 2012 and 2018, but this was offset by the costs of the visits. Staff reported that GIRFT's influence ranged from procurement changes to improved regional collaboration. CONCLUSION Nationally, we found substantial improvements in care, but the specific contribution of GIRFT cannot be reliably estimated due to other concurrent initiatives. Our approach enabled additional analysis of the discrete impact of GIRFT visits.
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Affiliation(s)
- Helen Barratt
- Department of Applied Health Research, University College London, London, UK
| | - Andrew Hutchings
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Elena Pizzo
- Department of Applied Health Research, University College London, London, UK
| | - Fiona Aspinal
- Department of Applied Health Research, University College London, London, UK
| | - Sarah Jasim
- Care Policy & Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Rafael Gafoor
- Department of Applied Health Research, University College London, London, UK
| | - Jean Ledger
- Department of Applied Health Research, University College London, London, UK
| | - Raj Mehta
- Department of Applied Health Research, University College London, London, UK
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Martin
- Department of Applied Health Research, University College London, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
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de Souza Gutierrez C, Bottega K, de Jezus Castro SM, Gravina GL, Toralles EK, Silveira Martins OR, Caumo W, Stefani LC. The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients. PLoS One 2021; 16:e0257941. [PMID: 34780486 PMCID: PMC8592468 DOI: 10.1371/journal.pone.0257941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 09/14/2021] [Indexed: 11/19/2022] Open
Abstract
Background Practical use of risk predictive tools and the assessment of their impact on outcome reduction is still a challenge. This pragmatic study of quality improvement (QI) describes the preoperative adoption of a customised postoperative death probability model (SAMPE model) and the evaluation of the impact of a Postoperative Anaesthetic Care Unit (PACU) pathway on the clinical deterioration of high-risk surgical patients. Methods A prospective cohort of 2,533 surgical patients compared with 2,820 historical controls after the adoption of a quality improvement (QI) intervention. We carried out quick postoperative high-risk pathways at PACU when the probability of postoperative death exceeded 5%. As outcome measures, we used the number of rapid response team (RRT) calls within 7 and 30 postoperative days, in-hospital mortality, and non-planned Intensive Care Unit (ICU) admission. Results Not only did the QI succeed in the implementation of a customised risk stratification model, but it also diminished the postoperative deterioration evaluated by RRT calls on very high-risk patients within 30 postoperative days (from 23% before to 14% after the intervention, p = 0.05). We achieved no survival benefits or reduction of non-planned ICU. The small group of high-risk patients (13% of the total) accounted for the highest proportion of RRT calls and postoperative death. Conclusion Employing a risk predictive tool to guide immediate postoperative care may influence postoperative deterioration. It encouraged the design of pragmatic trials focused on feasible, low-technology, and long-term interventions that can be adapted to diverse health systems, especially those that demand more accurate decision making and ask for full engagement in the control of postoperative morbi-mortality.
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Affiliation(s)
- Claudia de Souza Gutierrez
- Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Anaesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Katia Bottega
- Anaesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Gabriela Leal Gravina
- Anaesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Eduardo Kohls Toralles
- Anaesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Wolnei Caumo
- Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Surgery, School of Medicine, UFRGS, Porto Alegre, Brazil
- Laboratory of Pain & Neuromodulation, School of Medicine, UFRGS, Porto Alegre, Brazil
| | - Luciana Cadore Stefani
- Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Anaesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Department of Surgery, School of Medicine, UFRGS, Porto Alegre, Brazil
- * E-mail:
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van Dalen ASHM, Strandbygaard J, van Herzeele I, Boet S, Grantcharov TP, Schijven MP. Six Sigma in surgery: how to create a safer culture in the operating theatre using innovative technology. Br J Anaesth 2021; 127:817-820. [PMID: 34593216 DOI: 10.1016/j.bja.2021.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/26/2021] [Accepted: 08/16/2021] [Indexed: 01/05/2023] Open
Abstract
Safe delivery of patient care in the operating theatre is complex and co-dependent of many individual, organisational, and environmental factors, including patient, task and technology, individual, and human factors. The Six Sigma approach aims to implement a data-driven strategy to reduce variability and consequently improve safety. Analytical data platforms such as a Black Box ought to be embraced to support process optimisation and ultimately create a higher level of Six Sigma safety performance of the operating theatre team.
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Affiliation(s)
| | | | - Isabelle van Herzeele
- Department of Thoracic and Vascular Surgery, UZ Gent, University of Gent, Ghent, Belgium
| | - Sylvain Boet
- Department of Anaesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Teodor P Grantcharov
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Marlies P Schijven
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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Peden CJ, Miller TR, Deiner SG, Eckenhoff RG, Fleisher LA. Improving perioperative brain health: an expert consensus review of key actions for the perioperative care team. Br J Anaesth 2021; 126:423-432. [PMID: 33413977 DOI: 10.1016/j.bja.2020.10.037] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 12/13/2022] Open
Abstract
Delirium and postoperative neurocognitive disorder are the commonest perioperative complications in patients more than 65 yr of age. However, data suggest that we often fail to screen patients for preoperative cognitive impairment, to warn patients and families of risk, and to take preventive measures to reduce the incidence of perioperative neurocognitive disorders. As part of the American Society of Anesthesiologists (ASA) Perioperative Brain Health Initiative, an international group of experts was invited to review published best practice statements and guidelines. The expert group aimed to achieve consensus on a small number of practical recommendations that could be implemented by anaesthetists and their partners to reduce the incidence of perioperative neurocognitive disorders. Six statements were selected based not only on the strength of the evidence, but also on the potential for impact and the feasibility of widespread implementation. The actions focus on education, cognitive and delirium screening, non-pharmacologic interventions, pain control, and avoidance of antipsychotics. Strategies for effective implementation are discussed. Anaesthetists should be key members of multidisciplinary perioperative care teams to implement these recommendations.
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Affiliation(s)
- Carol J Peden
- Department of Anesthesiology, Keck Medicine of the University of Southern California, Los Angeles, CA, USA.
| | | | - Stacie G Deiner
- Department of Anesthesiology, Dartmouth Hitchcock Medical Centre, Lebanon, NH, USA
| | - Roderic G Eckenhoff
- Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lee A Fleisher
- Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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de Graaff JC, Engelhardt T. How big data shape paediatric anaesthesia. Br J Anaesth 2019; 119:448-451. [PMID: 28969311 DOI: 10.1093/bja/aex158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- J C de Graaff
- Department of Anesthesiology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - T Engelhardt
- Royal Aberdeen Children's Hospital, Aberdeen, Scotland AB25?2ZN, UK
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8
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Anesthesia Quality Improvement on Both Sides of the Atlantic. Int Anesthesiol Clin 2018; 57:131-143. [PMID: 30520753 DOI: 10.1097/aia.0000000000000211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Peden CJ, Mythen MG, Vetter TR. Population Health Management and Perioperative Medicine. Anesth Analg 2018; 126:397-399. [DOI: 10.1213/ane.0000000000002750] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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10
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Peden C, Campbell M, Aggarwal G. Quality, safety, and outcomes in anaesthesia: what's to be done? An international perspective. Br J Anaesth 2017; 119:i5-i14. [DOI: 10.1093/bja/aex346] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Moonesinghe S, Peden C. Theory and context: putting the science into improvement. Br J Anaesth 2017; 118:482-484. [DOI: 10.1093/bja/aew469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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12
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Moonesinghe SR, Grocott MPW, Bennett-Guerrero E, Bergamaschi R, Gottumukkala V, Hopkins TJ, McCluskey S, Gan TJ, Mythen MMG, Shaw AD, Miller TE. American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on measurement to maintain and improve quality of enhanced recovery pathways for elective colorectal surgery. Perioper Med (Lond) 2017; 6:6. [PMID: 28331608 PMCID: PMC5356230 DOI: 10.1186/s13741-017-0062-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 02/27/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This article sets out a framework for measurement of quality of care relevant to enhanced recovery pathways (ERPs) in elective colorectal surgery. The proposed framework is based on established measurement systems and/or theories, and provides an overview of the different approaches for improving clinical monitoring, and enhancing quality improvement or research in varied settings with different levels of available resources. METHODS Using a structure-process-outcome framework, we make recommendations for three hierarchical tiers of data collection. DISCUSSION Core, Quality Improvement, and Best Practice datasets are proposed. The suggested datasets incorporate patient data to describe case-mix, process measures to describe delivery of enhanced recovery and clinical outcomes. The fundamental importance of routine collection of data for the initiation, maintenance, and enhancement of enhanced recovery pathways is emphasized.
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Affiliation(s)
- S Ramani Moonesinghe
- UCLH NIHR Surgical Outcomes Research Centre and NIAA Health Services Research Centre, Royal College of Anaesthetists, London, UK
| | | | | | - Roberto Bergamaschi
- Department of Surgery, Stony Brook University School of Medicine, New York, USA
| | | | - Thomas J Hopkins
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina USA
| | - Stuart McCluskey
- Department of Anesthesia, University of Toronto, Toronto, ON USA
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University School of Medicine, New York, USA
| | - Michael Monty G Mythen
- Department of Anaesthesia and Perioperative Medicine, University College London, London, UK
| | - Andrew D Shaw
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee USA
| | - Timothy E Miller
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina USA
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