An approach to quality management in anaesthesia: a focus on perioperative care and outcome:

[The practice of postanesthesia visits - a questionnaire study]

BACKGROUND AND OBJECTIVE

Regular postanesthesia visits allow the detection of anesthesia related complications and increase patient satisfaction. Consequently, the performance of postanesthesia visits has been recommended after certain types of anesthesia. However, no data is available concerning the current practice of postanesthesia visits. Therefore, this study was designed to investigate quantity, organization, contents, significance and problems of postanesthesia visits in Germany.

METHODS

For this prospective closed-design survey, a questionnaire, consisting of 13 questions, was designed and tested for objectivity, reliability and validity. Subsequently, 3955 registered anesthesiologists were contacted via email to answer this survey.

RESULTS

Return rate was 31.4%; 958 questionnaires were included in the study. Only a small portion of patients was estimated to receive a postanesthesia visit (median: 20.0%). In hospitals with a specific postanesthesia visit service, this number was significantly higher (median: 65.0%, p<0.001) vs. no postanesthesia visit service. Postanesthesia visits usually lasted less than 5minutes (60.0%), and were typically conducted on the day of surgery (48.0%), after regular working hours (55.0%). 38.0% of the respondents reported to detect perioperative complications intermittently during their visits. While 98.0% of all respondents believe that postanesthesia visits improve the quality of their own work, 86.0% of the participants complain a lack of time for this task.

CONCLUSIONS

Our survey indicates that current working conditions prevent a regular postanesthesia visit routine. Considering the high appreciation of postanesthesia visits by anesthesiologists, as well as the relevant incidence of postoperative complications detected during these visits, it seems desirable to consider organizational improvements for postanesthesia care.

An anaesthesia information management system as a tool for a quality assurance program: 10years of experience

INTRODUCTION

Anaesthesia Information Management Systems (AIMS) generate large amounts of data, which might be useful for quality assurance programs. This study was designed to highlight the multiple contributions of our AIMS system in extracting quality indicators over a period of 10years.

METHODS

The study was conducted from 2002 to 2011. Two methods were used to extract anaesthesia indicators: the manual extraction of individual files for monitoring neuromuscular relaxation and structured query language (SQL) extraction for other indicators which were postoperative nausea and vomiting (PONV), pain, sedation scores, pain-related medications, scores and postoperative hypothermia. For each indicator, a program of information/meetings and adaptation/suggestions for operating room and PACU personnel was initiated to improve quality assurance, while data were extracted each year.

RESULTS

The study included 77,573 patients. The mean overall completeness of data for the initial years ranged from 55 to 85% and was indicator-dependent, which then improved to 95% completeness for the last 5years. The incidence of neuromuscular monitoring was initially 67% and then increased to 95% (P<0.05). The rate of pharmacological reversal remained around 53% throughout the study. Regarding SQL data, an improvement of severe postoperative pain and PONV scores was observed throughout the study, while mild postoperative hypothermia remained a challenge, despite efforts for improvement.

DISCUSSION

The AIMS system permitted the follow-up of certain indicators through manual sampling and many more via SQL extraction in a sustained and non-time-consuming way across years. However, it requires competent and especially dedicated resources to handle the database.

Public reporting in Germany: the content of physician rating websites

BACKGROUND

Physician rating websites (PRWs) are gaining in popularity among patients seeking quality information about physicians. However, little knowledge is available about the quantity and type of information provided on the websites.

OBJECTIVE

To determine and structure the quantity and type of information about physicians in the outpatient sector provided on German-language physician rating websites.

METHODS

In a first step, we identified PRWs through a systematic internet search using German keywords from a patient´s perspective in the two search engines Google and Yahoo. Afterwards, information about physicians available on the websites was collected and categorised according to Donabedian´s structure/process/outcome model. Furthermore, we investigated whether the information was related to the physician himself/ herself or to the practice as a whole.

RESULTS

In total, eight PRWs were detected. Our analysis turned up 139 different information items on eight websites; 67 are related to the structural quality, 4 to process quality, 5 to outcomes, and 63 to patient satisfaction/experience. In total, 37% of all items focus specifically on the physician and 63% on the physician's practice. In terms of the total amount of information provided on the PRWs, results range from 61 down to 13.5 items.

CONCLUSIONS

A broad range of information is available on German PRWs. While structural information can give a detailed overview of the financial, technical and human resources of a practice, other outcome measures have to be interpreted with caution. Specifically, patient satisfaction results are not risk-adjusted, and thus, are not appropriate to represent a provider's quality of care. Consequently, neither patients nor physicians should yet use the information provided to make their final decision for or against an individual physician.

Impact of a long specialized training in anaesthesia on the quality of care in a developing country: experience in Laos

OBJECTIVES

Assess the impact on the quality of practices in a developing country (Lao Democratic People's Republic) of a long specialized course in anaesthesia (Certificate of Specialized Studies in Anesthesia-Intensive care and Emergency Medicine [Cesarmu]) versus accelerated trainings.

POPULATION AND METHOD

Study concerned all surgical hospitals and all anaesthesiologists of Lao PDR. At hospital level, the quality of care was assessed and compared between hospitals with and without Cesarmu anaesthetists by using the quality of anaesthesia record and the spinal anaesthesia frequency in lower gyneco-obstetrical surgery. On an individual level, we assessed and compared anaesthetists who were Cesarmu trained and those who were not by using theoretical and practical scores. The latter were acquired by observing complete perisurgical care (pre-, per- and postoperative practical scores).

RESULTS

We visited 29 of the 34 surgical hospitals in Lao PDR and met 90 of the 111 anesthesiologists. At hospital level, quality criteria were higher in the group of hospitals with Cesarmu anaesthesiologists without that difference being significant. On the other hand, all individual scores measured were significantly higher in the Cesarmu group.

DISCUSSION

The improvement of practices resulting from training was obvious at the individual level but its impact at hospital level was not significant. There were most likely not enough trained anaesthetists to significantly influence practices in their departments.

CONCLUSION

According to the criteria used, the impact of Cesarmu on the quality of anaesthesia in Lao PDR seems positive. However, training needs to be continued and practices homogenized.

Customer focused incident monitoring in anaesthesia

The database of incident forms relating to anaesthesia services in an institutional risk management programme were reviewed for 2003-2005, the aim being to identify any recurring patterns. Incidents were prospectively categorised as relating to attitude/behaviour, communication breakdown, delay in service, or were related to care, cost, environment, equipment, security, administrative process, quality of service or miscellaneous. The total number of anaesthesia-related incidents reported during the period was 287, which related to 0.44% of the total number of anaesthetics administered during the time period. In all, 170 incidents were reported by the department, 96 by internal customers and 21 by external customers. Only 30% of the complaints came from the operating room. Thirty-four per cent of all incidents related to communication, behaviour and delay in service. A requirement to teach communication skills and stress handling formally in anaesthesia training programmes, and at the time of induction of staff into the department, has been identified.

Ambulatory surgery: an overview

PURPOSE OF REVIEW

Ambulatory surgery is now one of the major areas of surgical and anesthetic practice, with up to 70% of procedures performed in the ambulatory setting. This review focuses on some of the recent studies performed in day case anesthesia.

RECENT FINDINGS

Emphasizing the economic benefits of ambulatory surgery, investigators have studied the cost implications of various anesthetic techniques and their impact on patient recovery, discharge times and readmission rates. Quality anesthetic management measures such as mortality, morbidity, postoperative stay and patient satisfaction ensure that perioperative care and treatment are optimized.

SUMMARY

Careful patient selection can minimize perioperative events. The concept of multimodal analgesic and antiemetic therapy, in combination with newer anesthetic drugs, help expand the field of ambulatory surgery.