Regional anaesthesia quality indicators for adult patients undergoing non‐cardiac surgery: a systematic review

Abstract

Summary Improvement in healthcare delivery depends on the ability to measure outcomes that can direct changes in the system. An overview of quality indicators within the field of regional anaesthesia is lacking. This systematic review aims to synthesise available quality indicators, as per the Donabedian framework, and provide a concise overview of evidence‐based quality indicators within regional anaesthesia. A systematic literature search was conducted using the databases MEDLINE, Embase, CINAHL and Cochrane from 2003 to present, and a prespecified search of regional anaesthesia society websites and healthcare quality agencies. The quality indicators relevant to regional anaesthesia were subdivided into peri‐operative structure, process and outcome indicators as per the Donabedian framework. The methodological quality of the indicators was determined as per the Oxford Centre for Evidence‐Based Medicine's framework. Twenty manuscripts met our inclusion criteria and, in total, 68 unique quality indicators were identified. There were 4 (6%) structure, 12 (18%) process and 52 (76%) outcome indicators. Most of the indicators were related to the safety (57%) and effectiveness (19%) of regional anaesthesia and were general in nature (60%). In addition, most indicators (84%) were based on low levels of evidence. Our study is an important first step towards describing quality indicators for the provision of regional anaesthesia. Future research should focus on the development of structure and process quality indicators and improving the methodological quality and usability of these indicators.

Core outcome set for peripheral regional anesthesia research: a systematic review and Delphi study

“…Subsequent literature review demonstrated uptake of the COS in 60%–70% of trials by 200916 and over 80% by 2017,17 with a further review in 201918 showing sustained uptake at this level. Quality indicators in regional anesthesia have been evaluated and reviewed recently,19 20 with calls to create consensus on what defines success in regional anesthesia 21. To our knowledge, this is the first COS in this area.…”

Quality indicators for anesthesia and perioperative medicine

“…Furthermore, quality indicators should also produce reliable and valid results [ 39 ]. However, several systematic reviews found that most quality indicators used in routine perioperative care were based on low level or no scientific evidence [ 7 , 44 , 45 ▪ , 46 ▪▪ ]. Conversely, clinical indicators should be feasible and applicable for potential audiences [ 39 ], but evidence-based indicators validated for research purposes are not always practicable in routine care.…”

“…Professional societies and other organizations have practically developed and worked with perioperative quality indicators for a long time. Such empirical indicators often lack a robust basis of scientific evidence [ 7 , 44 , 45 ▪ , 46 ▪▪ ], but they are usually feasible in routine care. Several anesthesiologists’ societies have published perioperative quality indicator sets on the internet (for details and abbreviations, see Table 1 ).…”

“…Numerous problems complicate the establishment of a generally accepted, standardized, valid, feasible, and short but comprehensive core set of perioperative quality indicators. Indicator sets in clinical use are rarely based on high levels of evidence [ 7 , 44 , 45 ▪ , 46 ▪▪ ]. Composition of such sets and indicator definitions may be strikingly heterogeneous (see Table 1 ).…”

Advancing towards the next frontier in regional anaesthesia

“…To do this, we need sustained investment into high-quality studies that demonstrate the impact it has on outcomes beyond just acute pain. Both Hamilton et al and Johnston et al provide a succinct overview of appropriate metrics worthy of evaluation, as well as frameworks such as the Institute for Healthcare Improvement's triple aim [27] for thinking about how regional anaesthesia may improve healthcare in general [28,29]. Investigation into important long-term patient outcomes such as chronic postoperative pain and cancer recurrence must also continue as there is a sound mechanistic rationale for peri-operative management incorporating regional anaesthesia, even if the clinical evidence is as yet somewhat equivocal [30,31].…”