The goal of medical quality management (QM) is to improve patient outcomes and increase the efficiency of medical services. Quality management in anesthesia is an important guarantee of anesthesia safety.
The implementation of the QM program can be briefly summarized in seven steps.
1. Designate the person responsible for implementing QM in the department and establish a team
Successful QM relies on the QM responsible physician and his or her team. This person can be the department head or deputy head, or a QM specialist, who should organize other physicians and establish a QM committee or departmental QM team to collect, analyze, and review QM data and propose a response plan. The members of the QM management team should communicate smoothly and trust each other, and report to the department director and other members of the department in a timely manner the achievements and problems found by the QM team as well as the corresponding correction plans.
2, develop anesthesia adverse event measurement index
Anesthesia quality management covers three major aspects: structure, process and outcome, and its assessment and evaluation need measurable and meaningful quality indicators, so the anesthesia quality control indicators are mainly for these three aspects. While anesthesia outcome indicators are particularly important for anesthesia patient safety and the operational efficiency of medical care, structural and process indicators should not be neglected. Anesthesia quality management can be assessed and evaluated by monitoring anesthesia adverse events. Anesthesia adverse event metrics can include any variable from how many patients die (mortality) to how often the hospital replaces light bulbs in the locker room. Indicators can reflect structure (how many providers, how many operating rooms), process (how many patients receive perioperative antibiotics) and outcome (how many patients die).
Indicator Measurement
Analysis and Correction
Indicator re-measurement
3.Collect data and establish anesthesia quality management database
Anesthesia quality data generally comes from electronic anesthesia records or hospital information systems. The database is created by manual filling or by “automatic capture” of electronic information. Some commercial products are available to help with this process, and many departments have developed their own databases in paper or electronic form.
4. Reporting quality management of anesthesia
Regular reporting to the department and hospital should be done on a regular basis with three concepts in mind.
Some data should be reported as incidence: (e.g. headache after dural puncture).
Data should be reported monthly or quarterly. Trends that can be observed on the data.
Data (especially outcomes) are confounded by external factors and risk adjustment should be implemented before reporting.
For example, trauma center reporting includes: anesthesia mortality (incidence), quarterly reporting (observed trends), adjustment for severity of patient injury, and comparison with other trauma center mortality rates.
5. Review of abnormal events
In general, anesthesia complications are rare, and statistical evaluation often requires large numbers. Unusual events (e.g., critical errors) should be submitted to the QM committee for review and discussion. The discussion should focus on what happened and how to prevent it from happening again. When many unusual events occur, they should be “focused reviews” by experts who are responsible for identifying possible causes and possible solutions. Medicine is “more art than science”, so individual cases and unusual events are as important as numerical assessments.
6.Propose corrective measures
Sometimes quality can be improved through simple data reporting or discussion of abnormal events, especially for rare but serious events that are the basis of traditional “morbidity and mortality” meetings. Public presentation of data can be used to improve quality by leveraging peer pressure, for example, to improve compliance with systems, norms, and standards by medical staff.
Most anesthesia quality management activities should be done on a departmental level because people are sensitive to their own work environment. Most serious adverse events turn out to be systemic problems, not problems of individual errors. Analysis and discussion of events should focus on systemic improvements to prevent recurrence.
7, re-measurement and data collection, making full use of information technology
Data allows us to find out where the problem lies. Information technology helps QM data accumulate and makes QM easy and effective. Regular reporting increases anesthesiologists’ confidence in QM results. Anesthesia QM should strive to achieve: integrate indicator measurement reports into clinical practice, and make data collection and analysis a routine task.