Skip to main content
Top
Published in: Current Anesthesiology Reports 4/2017

Open Access 01-12-2017 | Patient Safety in Anesthesia (A Barbeito, Section Editor)

Improvement Science in Anaesthesia

Authors: Duncan T. Wagstaff, James Bedford, S. Ramani Moonesinghe

Published in: Current Anesthesiology Reports | Issue 4/2017

Login to get access

Abstract

Purpose of Review

This article offers an overview of the history and features of Improvement Science in general and some of its applications to Anaesthesia in particular.

Recent Findings

Improvement Science is an evolving discipline aiming to generate learning from quality improvement interventions. An increasingly common approach to improving Anaesthesia services is to employ large-scale perioperative data measurement and feedback programmes. Improvement Science offers important insights on questions such as which indicators to collect data for; how to capture that data; how it can be presented in engaging visual formats; how it could/should be fed back to frontline staff and how they can be supported in their use of data to generate improvement.

Summary

Data measurement and feedback systems represent opportunities for anaesthetists to work with multidisciplinary colleagues to help improve services and outcomes for surgical patients. Improvement Science can help evaluate which approaches work, and in which contexts, and is therefore of value to healthcare commissioners, providers and patients.
Literature
1.
2.
go back to reference Shojania KG, Grimshaw JM. Evidence-based quality improvement: the state of the science. Health Aff. 2005;24:138–50.CrossRef Shojania KG, Grimshaw JM. Evidence-based quality improvement: the state of the science. Health Aff. 2005;24:138–50.CrossRef
5.
go back to reference • Berwick DM. The science of improvement. JAMA J Am Med Assoc. 2008;299:1182–4. A commentary article discussing the emergence of improvement science and some of the barriers to adoption of change within healthcare systems. A good starting point to those with little knowledge of Improvement Science. CrossRef • Berwick DM. The science of improvement. JAMA J Am Med Assoc. 2008;299:1182–4. A commentary article discussing the emergence of improvement science and some of the barriers to adoption of change within healthcare systems. A good starting point to those with little knowledge of Improvement Science. CrossRef
8.
go back to reference Pawson R, Tilley N. Realistic evaluation. Newcastle upon Tyne: Sage; 1997. Pawson R, Tilley N. Realistic evaluation. Newcastle upon Tyne: Sage; 1997.
10.
go back to reference Goeschel CA, Weiss WM, Pronovost PJ. Using a logic model to design and evaluate quality and patient safety improvement programs. Int J Qual Heal Care. 2012;24:330–7.CrossRef Goeschel CA, Weiss WM, Pronovost PJ. Using a logic model to design and evaluate quality and patient safety improvement programs. Int J Qual Heal Care. 2012;24:330–7.CrossRef
11.
go back to reference Dixon-Woods M, Leslie M, Bion J, Tarrant C. What counts? An ethnographic study of infection data reported to a patient safety program. Milbank Q. 2012;90:548–91.CrossRefPubMedPubMedCentral Dixon-Woods M, Leslie M, Bion J, Tarrant C. What counts? An ethnographic study of infection data reported to a patient safety program. Milbank Q. 2012;90:548–91.CrossRefPubMedPubMedCentral
16.
go back to reference Montroy J, Breau RH, Cnossen S, Witiuk K, Binette A, Ferrier T, et al. Change in adverse events after enrollment in the national surgical quality improvement program: a systematic review and meta-analysis. PLoS One. 2016;11:1–14.CrossRef Montroy J, Breau RH, Cnossen S, Witiuk K, Binette A, Ferrier T, et al. Change in adverse events after enrollment in the national surgical quality improvement program: a systematic review and meta-analysis. PLoS One. 2016;11:1–14.CrossRef
18.
go back to reference Fulop N, Robert G. Context for successful quality improvement. London; 2015. Fulop N, Robert G. Context for successful quality improvement. London; 2015.
19.
go back to reference Charles D, Gabriel M, Searcy T, Carolina N, Carolina S. Adoption of electronic health record systems among U.S. Non-Federal Acute Care Hospitals: 2008–2014. ONC Data Br. 2015;4:1–10.CrossRef Charles D, Gabriel M, Searcy T, Carolina N, Carolina S. Adoption of electronic health record systems among U.S. Non-Federal Acute Care Hospitals: 2008–2014. ONC Data Br. 2015;4:1–10.CrossRef
21.
go back to reference • Etzioni D, Nabil W, Dueck A, Cima RR, Hohmann SF, Naessens JM, et al. Association of hospital participation in a surgical outcomes monitoring program with inpatient complications and mortality. JAMA J Am Med Assoc. 2015;313:505–11. Sentinal paper reporting outcomes from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). The first reported programme aimed at delivering quality improvement at a national scale CrossRef • Etzioni D, Nabil W, Dueck A, Cima RR, Hohmann SF, Naessens JM, et al. Association of hospital participation in a surgical outcomes monitoring program with inpatient complications and mortality. JAMA J Am Med Assoc. 2015;313:505–11. Sentinal paper reporting outcomes from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). The first reported programme aimed at delivering quality improvement at a national scale CrossRef
26.
go back to reference Iezzoni LI. Risk adjustment for measuring health care outcomes. 4th ed. Chicago: Health Administration Press; 2012. Iezzoni LI. Risk adjustment for measuring health care outcomes. 4th ed. Chicago: Health Administration Press; 2012.
27.
go back to reference Ivers N, Jamtvedt G, Flottorp S, Jm Y, Sd F, Ma OB, et al. Audit and feedback: effects on professional practice and healthcare outcomes ( review ). Cochrane Database Syst Rev. 2012;6:1–227. Ivers N, Jamtvedt G, Flottorp S, Jm Y, Sd F, Ma OB, et al. Audit and feedback: effects on professional practice and healthcare outcomes ( review ). Cochrane Database Syst Rev. 2012;6:1–227.
29.
go back to reference •• McQuillan RF, Silver SA, Harel Z, Weizman A, Thomas A, Bell C, et al. How to measure and interpret quality improvement data. Clin J Am Soc Nephrol 2016; 11:908–914. DOI: https://doi.org/10.2215/CJN.11511015. This article gives an overview of methods used to design and carry out a quality improvement project. It introduces the reader to methods used in Improvement Science, using a clinical example as a basis. A very useful read for anyone planning a quality improvement project. •• McQuillan RF, Silver SA, Harel Z, Weizman A, Thomas A, Bell C, et al. How to measure and interpret quality improvement data. Clin J Am Soc Nephrol 2016; 11:908–914. DOI: https://​doi.​org/​10.​2215/​CJN.​11511015. This article gives an overview of methods used to design and carry out a quality improvement project. It introduces the reader to methods used in Improvement Science, using a clinical example as a basis. A very useful read for anyone planning a quality improvement project.
30.
go back to reference • Benneyan JC, Lloyd RC, Plsek PE. Statistical process control as a tool for research and healthcare improvement. Qual Saf Health Care. 2003;12:458–64. This article discusses the application of Statistical Process Control Charts—a method of continuously monitoring processes and outcome commonly used in Improvement Science. It provides a clear introduction to their design and use for those without prior knowledge and would also be a useful revision article for those with pevious experience of them. CrossRefPubMedPubMedCentral • Benneyan JC, Lloyd RC, Plsek PE. Statistical process control as a tool for research and healthcare improvement. Qual Saf Health Care. 2003;12:458–64. This article discusses the application of Statistical Process Control Charts—a method of continuously monitoring processes and outcome commonly used in Improvement Science. It provides a clear introduction to their design and use for those without prior knowledge and would also be a useful revision article for those with pevious experience of them. CrossRefPubMedPubMedCentral
31.
go back to reference Lovegrove J, Valencia O, Treasure T, Sherlaw-Johnson C, Gallivan S. Monitoring the results of cardiac surgery by variable life-adjusted display. Lancet. 1997;350:1128–30.CrossRefPubMed Lovegrove J, Valencia O, Treasure T, Sherlaw-Johnson C, Gallivan S. Monitoring the results of cardiac surgery by variable life-adjusted display. Lancet. 1997;350:1128–30.CrossRefPubMed
32.
go back to reference Sherlaw-Johnson C. A method for detecting runs of good and bad clinical outcomes on variable life-adjusted display (VLAD) charts. Health Care Manag Sci. 2005;8:61–5.CrossRefPubMed Sherlaw-Johnson C. A method for detecting runs of good and bad clinical outcomes on variable life-adjusted display (VLAD) charts. Health Care Manag Sci. 2005;8:61–5.CrossRefPubMed
33.
go back to reference Pagel C, Utley M, Crowe S, Witter T, Anderson D, Samson R, et al. Real time monitoring of risk-adjusted paediatric cardiac surgery outcomes using variable life-adjusted display: implementation in three UK centres. Heart. 2013;99:1445–50.CrossRefPubMedPubMedCentral Pagel C, Utley M, Crowe S, Witter T, Anderson D, Samson R, et al. Real time monitoring of risk-adjusted paediatric cardiac surgery outcomes using variable life-adjusted display: implementation in three UK centres. Heart. 2013;99:1445–50.CrossRefPubMedPubMedCentral
35.
go back to reference Foltran F, Baldi I, Bertolini G, Merletti F, Gregori D. Monitoring the performance of intensive care units using the variable life-adjusted display: a simulation study to explore its applicability and efficiency. J Eval Clin Pract. 2009;15:506–13.CrossRefPubMed Foltran F, Baldi I, Bertolini G, Merletti F, Gregori D. Monitoring the performance of intensive care units using the variable life-adjusted display: a simulation study to explore its applicability and efficiency. J Eval Clin Pract. 2009;15:506–13.CrossRefPubMed
36.
go back to reference Cook DA, Duke G, Hart GK, Pilcher D, Mullany D. Review of the application of risk-adjusted charts to analyse mortality outcomes in critical care. Crit Care Resusc. 2008;10:239–51.PubMed Cook DA, Duke G, Hart GK, Pilcher D, Mullany D. Review of the application of risk-adjusted charts to analyse mortality outcomes in critical care. Crit Care Resusc. 2008;10:239–51.PubMed
43.
go back to reference • Pearse RM. Enhanced peri-operative care for high-risk patients (EPOCH ) trial: a stepped wedge cluster randomised trial of a quality improvement intervention for patients undergoing emergency laparotomy. 2013;1–26. Available from: http://www.epochtrial.org/docs/EPOCH Protocol v1 0final.pdf. Study protocol for a large pragmatic clinical trial of the effectiveness of a quality improvement project to implement an evidence based care pathway to improve patient outcomes following emergency laparotomy. The trial is yet to report, but the protocol provides insight into a large multicentre quality improvement initiative. • Pearse RM. Enhanced peri-operative care for high-risk patients (EPOCH ) trial: a stepped wedge cluster randomised trial of a quality improvement intervention for patients undergoing emergency laparotomy. 2013;1–26. Available from: http://​www.​epochtrial.​org/​docs/​EPOCH Protocol v1 0final.​pdf. Study protocol for a large pragmatic clinical trial of the effectiveness of a quality improvement project to implement an evidence based care pathway to improve patient outcomes following emergency laparotomy. The trial is yet to report, but the protocol provides insight into a large multicentre quality improvement initiative.
45.
46.
go back to reference Dranove D, Kessler D, McClellan M, Satterthwaite M. Is more information better? The effects of “report cards” on health care providers. J Polit Econ. 2003;111:555–88.CrossRef Dranove D, Kessler D, McClellan M, Satterthwaite M. Is more information better? The effects of “report cards” on health care providers. J Polit Econ. 2003;111:555–88.CrossRef
Metadata
Title
Improvement Science in Anaesthesia
Authors
Duncan T. Wagstaff
James Bedford
S. Ramani Moonesinghe
Publication date
01-12-2017
Publisher
Springer US
Published in
Current Anesthesiology Reports / Issue 4/2017
Electronic ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-017-0234-5

Other articles of this Issue 4/2017

Current Anesthesiology Reports 4/2017 Go to the issue

Advances in Monitoring for Anesthesia (LAH Critchley, Section Editor)

Cardiac Output Monitoring: Validation Studies–how Results Should be Presented

Geriatric Anesthesia (S Akhtar, Section Editor)

Neuronal Connectivity, General Anesthesia, and the Elderly

Geriatric Anesthesia (S Akhtar, Section Editor)

Fluid Management in the Elderly