Quality of anesthesia care:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, PA
Saunders
2011
|
| Schriftenreihe: | Anesthesiology clinics
29,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XX, 178 S. Ill., graph. Darst. |
| ISBN: | 9781455704194 |
Internformat
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Datensatz im Suchindex
| _version_ | 1804143927071080448 |
|---|---|
| adam_text | Titel: Quality of anesthesia care
Autor: Neuman, Mark D.
Jahr: 2011
Contents
Foreword: Quality of Anesthesia Care xiii
Lee A. Fleisher
Preface: Finding the Fourth Branch-Understanding Quality-of-Care
in Anesthesiology xv
Mark D. Neuman and Elizabeth A. Martinez
Teamwork and Communication in the Operating Room: Relationship
to Discrete Outcomes and Research Challenges 1
Michael Nurok, Thoralf M. Sundt III, and Allan Frankel
The literature defining and addressing teamwork and communication is
abundant; however, few studies have analyzed the relationship between
measures of teamwork and communication and quantifiable outcomes.
The objectives of this review are: (1) to identify studies addressing team-
work and communication in the operating room in relation to discrete mea-
sures of outcome, (2) to create a classification of studies of the relationship
between teamwork and communication and outcomes, (3) to assess the
implications of these studies, (4) to explore the methodological challenges
of teamwork and communication studies in the perioperative setting, and
(5) to suggest future research directions.
Simulation and Quality Improvement in Anesthesiology 13
Christine S. Park
Simulation, a strategy for improving the quality and safety of patient care,
is used for the training of technical and nontechnical skills and for training
in teamwork and communication. This article reviews simulation-based re-
search, with a focus on anesthesiology, at 3 different levels of outcome: (1)
as measured in the simulation laboratory, (2) as measured in clinical perfor-
mance, and (3) as measured in patient outcomes. It concludes with a dis-
cussion of some current uses of simulation, which include the identification
of latent failures and the role of simulation in continuing professional
practice assessment for anesthesiologists.
Using Information Technology to Improve Quality in the OR 29
Brian Rothman, Warren S. Sandberg, and Paul St Jacques
This article summarizes the current state of technology as it pertains to qual-
ity in the operating room, ties the current state back to its evolutionary path-
way to understand how the current capabilities and their limitations came to
pass, and elucidates how the overlay of information technology (IT) as
a wrapper around current monitoring and device technology provides a sig-
nificant advance in the ability of anesthesiologists to use technology to im-
prove quality along many axes. The authors posit that IT will enable all the
information about patients, perioperative systems, system capacity, and
readiness to follow a development trajectory of increasing usefulness.
Using Real-Time Clinical Decision Support to Improve Performance
on Perioperative Quality and Process Measures 57
Anthony Chau and Jesse M. Ehrenfeld
Anesthesia information management systems (AIMS) are becoming more
commonplace in operating rooms across the world and have the potential
to help clinicians measure and improve perioperative quality. However, to
realize the full potential of AIMS, clinicians must first understand their ca-
pabilities and limitations. This article reviews the literature on AIMS, focus-
ing on areas where AIMS have been shown to have a meaningful impact
on quality, safety, and operational efficiency.
Outcomes Research Using Quality Improvement Databases: Evolving
Opportunities and Challenges 71
Satya Krishna Ramachandran and Sachin Kheterpal
The challenges to prospective randomized controlled trials have necessi-
tated the exploration of observational data sets that support research into
the predictors and modulators of preoperative adverse events. The pri-
mary purpose and design of quality improvement databases is quality
assessment and improvement at the local, regional, or national level. How-
ever, these data can also provide the opportunity to robustly study specific
questions related to patient outcomes with no additional clinical risk to the
patient. The virtual explosion of anesthesia-related registries has opened
seemingly limitless opportunities for outcomes research in addition to gen-
erating hypothesis for more rigorous prospective analysis.
Preventing Postoperative Complications in the Elderly 83
Frederick E. Sieber and Sheila Ryan Barnett
Postoperative complications are directly related to poor surgical outcomes
in the elderly. This review outlines evidence based quality initiatives
focused on decreasing neurologic, cardiac, and pulmonary complications
in the elderly surgical patient. Important anesthesia quality initiatives for
prevention of delirium, the most common neurologic complication in
elderly surgical patients, are outlined. There are few age-specific quality
measures aimed at prevention of cardiac and pulmonary complications.
However, some recommendations for adults can be applied to the geriatric
surgical population. In the future, process measures may provide a more
global assessment of quality in the elderly surgical population.
Improving Quality Through Multidisciplinary Education 99
Rikante Kveraga and Stephanie B. Jones
Multidisciplinary education (MDE) is perceived as the next means of imple-
menting major improvements in the quality and cost-effectiveness of
patient care. In this article, the authors discuss various definitions of
MDE, evaluate how MDE might be implemented in clinical arenas relevant
to the anesthesiologist, and describe several implementations of MDE
within their hospital and the anesthesiology department.
Health Care Quality in End-of-Life Care: Promoting Palliative Care in the
Intensive Care Unit 111
Rebecca Aslakson and Peter J. Pronovost
Seminal articles published in the late 1990s instigated not only an intense
interest in health care quality but also a new era of research into quality
end-of-life care, particularly in intensive care units (ICUs). ICUs can im-
prove health care quality at the end of life by better using palliative care
services and palliative care-related principles. This article details how
the interest in health care quality has spurred a similar interest in end-of-
life and palliative care in ICUs, defines palliative care and describes how
it improves health care quality, and highlights barriers to the incorporation
of palliative care in ICUs.
Quality Assurance and Assessment in Pain Management 123
Anita Gupta, Michael Ashburn, and Jane Ballantyne
Relief from pain is itself a marker of high-quality medical care. Quality assur-
ance in the case of pain management could simply mean successful elim-
ination of pain. Because the means of controlling pain are imperfect, it is
essential to consider whether pain interventions actually achieve the pri-
mary goal of pain relief and also whether they are safe, cost-effective,
and even capable of producing secondary benefits such as early recovery
from surgery. Quality assurance and assessment in pain management
therefore becomes a complex undertaking that must incorporate into its
processes the often-conflicting goals of comfort versus safety versus
patients rights.
Medication Safety in the Perioperative Setting 13S
George M. Hanna and Wilton C. Levine
Drug administration errors are a major cause of morbidity and mortality in
hospitalized patients. These errors result in major harm and incur dramatic
costs to the delivery of health care. This article highlights this problem,
especially as it deals with patients in the perioperative setting.
Reduction of Regulated Medical Waste Using Lean Sigma Results
in Financial Gains for Hospital 145
Jerry Stonemetz, Julius C. Pham, Alejandro J. Necochea, John McGready,
Robert E. Hody, and Elizabeth A. Martinez
This article describes how anesthesiologists can lead innovation and pro-
cess improvement focused on regulated medical waste reduction and
cost savings using a process improvement methodology known as Lean
Sigma.
An Anesthesiology Department Leads Culture Change at a Hospital
System Level to Improve Quality and Patient Safety 153
Peter M. Fleischut, Adam S. Evans, Susan L. Faggiani, Eliot J. Lazar,
and Gregory E. Kerr
At New York-Presbyterian Hospital, Weill Cornell Medical Center, an inno-
vative approach to involving housestaff in quality and patient safety, policy
and procedure creation, and culture change was led by the Department of
Anesthesiology of the Weill Medical College of Cornell University. A
Housestaff Quality Council was started in 2008 that has partnered with
hospital leadership and clinical departments to engage the housestaff in
quality and patient safety initiatives, resulting in measurable improvements
in several patient care projects and enhanced working relationships
among various clinical constituencies. Ultimately this attempt to change
culture has found great success in fostering a relationship between the
housestaff and the hospital in ways that have and will continue to improve
patient care.
Index 169
Erratum I
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| physical | XX, 178 S. Ill., graph. Darst. |
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| title | Quality of anesthesia care |
| title_auth | Quality of anesthesia care |
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