Linking Process and Outcome of Care in a Continuous Quality Improvement Program for Anesthesia Services

We developed a continous quality improvement (CQI) program for anesthesia services based on self- reporting of critical incidents and negative outcomes through a dichotomous (yes/no) response on the anes thesia record. Immediate case investigation provides data for systematic peer review of anesthesia man agement. Trend analysis of the database of critical incidents and negative outcomes identifies opportu nities for improvement. The CQI program resulted in the reporting of nearly twice as many problems re lated to anesthesia management (5% of all anes thetics) as did the checklist it replaced (2.7%). Esca lation of patient care (3.2%) and operational ineffi ciencies (2.2%) were more common than patient injury (1.5% of all anesthetics). Among the 537 cases with anesthesia management problems were 119 hu man errors and equipment problems (22%). Regional nerve blocks and airway management represented the most common problem areas. Improvement in anesthesia services was made through prompt imple mentation of strategies for problem prevention de vised by the practitioners themselves through peer review, literature review, and clinical investigations.