Using quality indicators in anaesthesia: feeding back data to improve care

Abstract

After recent UK policy developments, considerable attention has been focused upon how clinical specialties measure and report on the quality of care delivered to patients. Defining the right indicators alone is insufficient to close the feedback loop. This narrative review aims to describe and synthesize a diverse body of research relevant to the question of how information from quality indicators can be fed back and used effectively to improve care. Anaesthesia poses certain challenges in the identification of valid outcome indicators sensitive to variations in anaesthetic care. Metrics collected during the immediate post-anaesthetic recovery period, such as patient temperature, patient-reported quality of recovery, and pain and nausea, provide potentially useful information for the anaesthetist, yet this information is not routinely fed back. Reviews of the effects of feeding back performance data to healthcare providers suggest that this may result in small to moderate positive effects upon outcomes and professional practice, with stronger effects where feedback is integrated within a broader quality improvement strategy. The dominant model for use of data within quality improvement is based upon the industrial process control approach, in which care processes are monitored continuously for process changes which are rapidly detectable for corrective action. From this review and experience of implementing these principles in practice, effective feedback from quality indicators is timely, credible, confidential, tailored to the recipient, and continuous. Considerable further work is needed to understand how information from quality indicators can be fed back in an effective way to clinicians and clinical units, in order to support revalidation and continuous improvement.

Real-time physiologic monitoring and physician feedback: Are we ready?

“…Various QI endeavours have been shown to reduce operating room inefficiencies, improve antibiotic compliance, and reduce postoperative pneumonias. 3 An understanding of the barriers to implementation is paramount to the success of these QI enterprises. Simply monitoring data without providing feedback, lack of trust in data, and lack of motivation have all been cited as reasons for ineffective QI buy-in and implementation.…”

“…Simply monitoring data without providing feedback, lack of trust in data, and lack of motivation have all been cited as reasons for ineffective QI buy-in and implementation. 3 The study by Görges et al addresses such common barriers by providing feedback through the use of statistical control processes. Nevertheless, unlike a traditional audit that examines snapshot data over a brief amount of time, the use of a continuous form of data created through run charts (which display observed data over a set time sequence -typically a year), creates a data-rich environment for assessing current practice over time and evaluating the impact of changes to the care system.…”

“…Nevertheless, unlike a traditional audit that examines snapshot data over a brief amount of time, the use of a continuous form of data created through run charts (which display observed data over a set time sequence -typically a year), creates a data-rich environment for assessing current practice over time and evaluating the impact of changes to the care system. 3 Individualized feedback using such data can be a motivating factor for clinicians by providing objective data on clinical performance. 3 Moreover, Görges et al speculated that clinicians' intrinsic competitiveness through group feedback drove at least some of the improvements observed.…”

“…3 Individualized feedback using such data can be a motivating factor for clinicians by providing objective data on clinical performance. 3 Moreover, Görges et al speculated that clinicians' intrinsic competitiveness through group feedback drove at least some of the improvements observed. 1 It is possible that the provision of feedback results in a Hawthorne effect -i.e., that the knowledge of being measured actually changes behaviour.…”

“…Plusieurs initiatives d'amélioration de la qualité ont permis de réduire les inefficiences en salle d'opération, d'améliorer l'observance des antibiotiques, et de réduire les pneumonies postopératoires. 3 Une bonne compréhension des obstacles à la mise en oeuvre de telles tentatives d'amélioration de la qualité est absolument essentielle à leur réussite. La simple récolte de données sans rétroactions subséquentes, le manque de confiance dans les données, et le manque de motivation sont quelques-unes des raisons invoquées pour expliquer le manque de soutien de telles initiatives et une mise en oeuvre inefficace.…”