Mini-audits facilitate quality assurance in outpatient units

Abstract

P Pu ur rp po os se e: : It has been shown that large-scale epidemiological studies are an unsatisfactory method of measuring quality of care in anesthesia. We performed a mini-audit of the outpatient surgery unit at Vancouver General Hospital to determine whether such methodology would be helpful in assessing and monitoring quality of care and in identifying areas where improvements could be made.M Me et th ho od ds s: : After institutional approval, we conducted a prospective quality assurance audit in a cohort of 462 consecutive outpatients. A measurement tool was developed using information from previous literature. Data recorded included demographics, type of surgery and anesthesia, duration of stay in the postanesthetic care unit (PACU) and any adverse events in the PACU. The effect of ethnicity on the above was also examined.R Re es su ul lt ts s: : The demographics and practice profiles of our unit were comparable to other units. The mean duration of stay in the PACU was 91 ± 55.3 min and is twice as long as other units. The incidence of hypotension, hypothermia and excessive pain in the PACU were higher compared to other centres. The incidence of other adverse events was comparable to that reported by other centres. O 2 supplementation was required more frequently in Caucasians (23% vs 9%; P <0.05) and postoperative bleeding occurred more frequently in Asiatics (46% vs 27%; P <0.05).C Co on nc cl lu us si io on n: : A mini-audit was found to be helpful in assessing and monitoring quality of care and in identifying areas where improvements could be made.O Ob bj je ec ct ti if f : : On a déjà démontré que les études épidémiologiques à grande échelle ne constituent pas une méthode satisfaisante de mesure de la qualité des soins en anesthésie. Nous avons réalisé un mini-audit de l unité de chirurgie ambulatoire au Vancouver General Hospital afin de déterminer si cette méthodologie pouvait être utile pour évaluer et surveiller la qualité des soins et pour identifier des domaines susceptibles d amélioration.M Mé ét th ho od de e : : Après avoir obtenu l accord de l hôpital, nous avons réalisé un audit prospectif sur l assurance qualité auprès d une cohorte de 462 patients ambulatoires successifs. Un instrument de mesure a été mis au point en utilisant des renseignements provenant de documentation déjà publiée sur le sujet. Les données comprenaient des informations personnelles, le type de chirurgie et d anesthésie, la durée du séjour en salle de réveil (SDR) et les événements défavorables qui ont pu y survenir. On a aussi vérifié l effet de l origine ethnique sur ces données.R Ré és su ul lt ta at ts s : : Les données démographiques et les profiles de pratique de notre unité ont été comparables à d autres unités. La durée moyenne du séjour en SDR a été de 91 ± 55,3 min, ce qui est deux fois plus long que dans les autres unités. Lincidence d hypotension, d hypothermie et de douleur intense à la SDR a été plus élevée, en comparaison avec d autres centres. Lincidence d autres événements indésirables a été compar...

Meta-analysis of operative mortality and complications in patients from minority ethnic groups

“…No additional papers were identified by manual review of the reference lists of the original papers. The final set consisted of 26 published studies that underwent full‐text evaluation.…”

“…Nineteen studies 32 56 . 37,40,45,50,53,55 , and in three studies 36,41,54 ethnicity was determined by care providers. In one study 57 , ethnicity was determined by both the patient and a care provider; in one study 46 , ethnicity was determined by the patient and family members; and in another study 39 , ethnicity was determined by assessors.…”

“…†Non-North American study. , 18 studies 32,33,36 -39,41-43,45-47,50-55 reported postoperative complications (for example any complications, graft failure, stroke, wound infection), and 11 studies32,38,39,42,44,47,50,51,54,56,57 reported hospital or ICU length of stay. One other reported outcome was functional status…”

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“…Regular audits may facilitate quality assurance in ASU [31]. The knowledge of the possible occurrence of several complications, as well as the time spent by the patient at different steps of its pathway may facilitate the implementation of corrective actions.…”

Performance of a pediatric ambulatory anesthesia program – a developing country experience

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