Perioperative structure and process quality and safety indicators: a systematic review

Abstract

CRD4201501277.

Prioritisation of quality indicators for elective perioperative care: a Delphi consensus

“…A large number of process measures were identified in the perioperative indicators systematic review, but again, many lacked the high levels of evidence (Chazapis et al, 2018). Process measures are good targets for quality improvement, but it is important for this that they have a direct association with patient-centred outcomes (Boney et al, 2016).…”

“…A systematic review of perioperative process and structure indicators has recently evaluated both research and grey literature databases as well as professional and governmental body publications (Chazapis et al, 2018). This comprehensive review, covering an 11-year period (January 2005-January 2016), identified 1282 clinical indicators, which mainly focused on effectiveness (38%), safety (29%) and efficiency (26%).…”

Implementing risk calculators: time for the Trojan Horse?

“…It is wrong to assume that all systems and technologies used in high-income settings will lead to improvements elsewhere; however, availability of data from LMICs demonstrating a relationship between poor outcomes and lack of resources (e.g. critical care beds or availability of basic monitors, such as pulse oximetry and capnography) 9 might further support efforts to address these issues. This is particularly important when considering the competition for limited public finances that exist in Africa and similar settings.…”

“…Thus, the question is whether we should continue to rely only on reading a label, or take the view that the instances where coloured labels prevent mistakes will outweigh those when colour might predispose to other problems. This illustrates the complex adaptive nature of safety interventionsdhow humans and systems change, sometimes unpredictablydin response to one another, and can lead to safety paradoxes, 9 in which our defences can themselves cause unanticipated…”

Is THIS the way to better improvement?

“…1 Improvement work goes largely unevaluated, says Dixon-Woods, citing a study that found 1282 quality indicators for the entire surgical pathway in the NHS, most of which had no or little evidence behind them. 2 "People pluck them out of the air and use them," says Dixon-Woods. "It's a problem for research because it's very difficult to compare one study with the next.…”