Abstract:
While quality programs have been shown to improve provider compliance, few have demonstrated conclusive improvements in patient outcomes. We hypothesized that there would be increased metric compliance and decreased postoperative complications after initiation of an anesthesiology quality improvement program at our institution. We performed a retrospective study of all adult inpatients having anesthesia for a twelve-month period that spanned six months before and after program implementation. The primary outcome was the rate of complications in the post-implementation period. Secondary outcomes included the change in proportion of complications and compliance with quality metrics. We studied a total of 9620 adult inpatient cases, subdivided into pre- and post-implementation groups (4832 vs 4788.) After multivariate model adjustment, the rate of any complication (our primary outcome) was not significantly changed (32% to 31%; adjusted P = 0.410.) Of the individual complications, only wound infection (2.0% to 1.5%; adjusted P = 0.020) showed a statistically significant decrease. Statistically and clinically significant increases in compliance were seen for the BP-02 Avoiding Monitoring Gaps metric (81% to 93%, P < 0.001), both neuromuscular blockade metrics (NMB-01 76% to 91%, P < 0.001; NMB-02 95% to 97%, P = 0.006), both tidal volume metrics (PUL-01 84% to 93%, P < 0.001; PUL-02 30% to 45%, P < 0.001), and the TEMP-02 Core Temperature Measurement metric (88% to 94%, P < 0.001). Implementation of a comprehensive quality feedback program improved metric compliance but was not associated with a change in postoperative complications.
摘要:
虽然质量计划已被证明可以提高提供商的合规性,很少有人证明患者结局有决定性的改善.我们假设在我们机构启动麻醉质量改进计划后,指标依从性会提高,术后并发症会减少。我们对计划实施前后六个月的所有成年住院患者进行了为期十二个月的麻醉的回顾性研究。主要结果是实施后的并发症发生率。次要结果包括并发症比例的变化和对质量指标的依从性。我们共研究了9620例成人住院病例,细分为实施前和实施后的组(4832vs4788。)在多元模型调整后,任何并发症的发生率(我们的主要结局)没有显著变化(32%~31%;校正P=0.410.)在个体并发症中,仅伤口感染(2.0%~1.5%;调整后P=0.020)显示出统计学上显著的下降.BP-02避免监测差距指标的依从性在统计学和临床上显着增加(81%至93%,P<0.001),两种神经肌肉阻滞指标(NMB-0176%至91%,P<0.001;NMB-0295%至97%,P=0.006),两个潮气量指标(PUL-0184%至93%,P<0.001;PUL-0230%至45%,P<0.001),和TEMP-02核心温度测量指标(88%至94%,P<0.001)。实施全面的质量反馈计划可改善指标依从性,但与术后并发症的变化无关。