Institution of Monthly Anesthesia Quality Reports Does Not Reduce Postoperative Complications despite Improved Metric Co
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SYSTEMS-LEVEL QUALITY IMPROVEMENT
Institution of Monthly Anesthesia Quality Reports Does Not Reduce Postoperative Complications despite Improved Metric Compliance Patrick J. McCormick 1,2 & Cindy B. Yeoh 1,2 & Margaret Hannum 3 & Kay See Tan 3 & Raquel M. Vicario-Feliciano 4 & Meghana Mehta 1 & Gloria Yang 1 & Kaitlin Ervin 5 & Gregory W. Fischer 1,2 & Luis E. Tollinche 1,2 Received: 22 May 2020 / Accepted: 16 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract While quality programs have been shown to improve provider compliance, few have demonstrated conclusive improvements in patient outcomes. We hypothesized that there would be increased metric compliance and decreased postoperative complications after initiation of an anesthesiology quality improvement program at our institution. We performed a retrospective study of all adult inpatients having anesthesia for a twelve-month period that spanned six months before and after program implementation. The primary outcome was the rate of complications in the post-implementation period. Secondary outcomes included the change in proportion of complications and compliance with quality metrics. We studied a total of 9620 adult inpatient cases, subdivided into pre- and post-implementation groups (4832 vs 4788.) After multivariate model adjustment, the rate of any complication (our primary outcome) was not significantly changed (32% to 31%; adjusted P = 0.410.) Of the individual complications, only wound infection (2.0% to 1.5%; adjusted P = 0.020) showed a statistically significant decrease. Statistically and clinically significant increases in compliance were seen for the BP-02 Avoiding Monitoring Gaps metric (81% to 93%, P < 0.001), both neuromuscular blockade metrics (NMB-01 76% to 91%, P < 0.001; NMB-02 95% to 97%, P = 0.006), both tidal volume metrics (PUL-01 84% to 93%, P < 0.001; PUL-02 30% to 45%, P < 0.001), and the TEMP-02 Core Temperature Measurement metric (88% to 94%, P < 0.001). Implementation of a comprehensive quality feedback program improved metric compliance but was not associated with a change in postoperative complications. Keywords Perioperative complications . Quality improvement . Outcome measures . Physician evaluation . Automated feedback Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10916-020-01659-7) contains supplementary material, which is available to authorized users. * Patrick J. McCormick [email protected]
Gregory W. Fischer [email protected]
Cindy B. Yeoh [email protected]
Luis E. Tollinche [email protected]
Margaret Hannum [email protected]
1
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
2
Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
3
Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
4
School of Medicine, Medical Sciences Campus, University of Puerto Rico, San
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