Background
Method
Choice of QI
Quality indicator description form | |
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Definition | This quality indicator, expressed as a score, evaluates the state of the anesthesia file. For every file chosen at random, a quality score between 0 and 1 is calculated based on a maximum of 13 criteria. The closer the score is to 1, the higher the estimated quality of the file. |
Criteria | 1. Patient identification on every page of the file Pre-anesthesia 2. Anesthetist named in file (pre-anesthesia consultation or visit) 3. Records from pre-anesthesia visit attached (pre-anesthesia visit) 4. Ongoing medical treatment (or lack of treatment) recorded in file (pre-anesthesia consultation or visit) 5. Evaluation of anesthesia risk recorded in file (pre-anesthesia consultation or visit) 6. Type of anesthesia proposed to patient recorded in file (pre-anesthesia consultation or visit) 7. Pre-anesthesia evaluation of access to upper airways recorded in file (pre-anesthesia consultation or visit) Anesthesia during intervention 8. Anesthetist present during intervention named in file 9. Technical approach for access to upper airways recorded in file (if applicable) Immediate post-anesthesia care 10. Anesthetist present at post-intervention named in file (if applicable) 11. Anesthetist’s signature authorizing patient’s discharge from recovery room in file (if applicable) 12. Post-intervention medical prescriptions recorded (if applicable) Throughout 13. Space for recording peri-anesthesia incidents or accidents |
Sample Size | A sample size of 60 files in each health care organization is used to calculate an average score |
Type of Indicator | Process indicator. |
Composite indicator. | |
Risk adjustment: no. |
Case studies
HCO description | Study methods | ||||
---|---|---|---|---|---|
Type (Location) | Beds Anesthetists Nurses Cases/year (n) | Observation | Informal discussion | In-depth Interview | |
A | Private, not-for- profit (Paris region) | 339 | Yes | Yes | 1 Chief anesthetist (2×) |
14 | 1 Anesthetist | ||||
20 | 1 Nurse anesthetist | ||||
8470 | 1 Physician in charge of QIs | ||||
B | Public, university hospital (Paris) | 753 | Yes | Yes | 1 Chief anesthetist (2×) |
36 | 3 Anesthetists | ||||
46 | 3 Nurse anesthetists | ||||
17690 | 1 Quality manager | ||||
C | Public, university hospital (West of France) | 1318 | No | No | 1 Medical coordinator |
50 | 1 Chief anesthetist | ||||
90 | 1 Anesthetist | ||||
31460 | 1 Nurse anesthetist | ||||
D | Public (South of France) | 617 | Yes | Yes | 1 Medical coordinator |
15 | 1 Chief anesthetist | ||||
25 | 1 Anesthetist | ||||
12730 | 2 Nurse anesthetists | ||||
1 Quality manager | |||||
1 Surgeon | |||||
E | Private for Profit (East of France) | 162 | Yes | Yes | 1 Chief anesthetist |
8 | 1 Nurse anesthetist | ||||
16 | 1 Head nurse | ||||
15300 | 1 Quality manager | ||||
F | Private for Profit (Paris) | 237 | No | No | 1 Chief executive officer |
8 | 1 Chief anesthetist | ||||
NA | 1 Physician in charge of information systems | ||||
13400 | 1 Nurse anesthetist | ||||
Ga | Public (East of France) | 355 | Yes | Yes | 1 Chief anesthetist |
6 | 2 Anesthetists | ||||
10 | 1 Nurse anesthetist | ||||
6522 |
Data collection
Data analysis
Results
Limited perceived use of QAF and quality Improvements
Key role of clinical managers in QAF implementation
The major role of information system
HCO | Local manager | Digitalization of anesthesia record | Professional ties |
---|---|---|---|
A | Chief anesthetist | Yes | Very young team |
B | Chief anesthetist | No | Diffusion of best practices difficult because of large anesthesia team |
C | Chief anesthetist + 2 anesthetists | No | Diffusion of best practices difficult because of large anesthesia team |
D | Chief anesthetist + 1 anesthetist | No | New and merged facilities meant that many experienced anesthetists left whilst the improvement assessments were in progress, leaving work to a less experienced team |
E | Chief anesthetist | Yes (information system designed and installed by chief anesthetist. Both adapted and adaptable to user needs) | Private sector anesthetists caring little for institutional improvements apart from the chief anesthetist |
F | Chief anesthetist | No | Team little concerned with institutional improvements apart from the chief anesthetist who identified with patients and showed high commitment to the steps taken to improve quality |
G | Chief anesthetist | Yes (technical difficulties; junior anesthetists had to enter senior anesthetists’ written notes on their tablets but, as wi-fi did not work in the hospital wings, they had to reconvene in the operating rooms). | Strained relationship between the senior anesthetists resisting introduction of new technologies and practices and the chief anesthetist seeking compliance with QAF criteria |