The value of personal professional monitoring performance data and open disclosure policies in anaesthetic practice: a case report

Bolsin, Stephen; Solly, Ruby; Patrick, Andrew

doi:10.1136/qhc.12.4.295

Cited by 15 publications

(15 citation statements)

References 10 publications

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“…We hope that widespread implementation of an affordable model, which has already achieved documented benefits for users and providers of health care in Australia, can be rapidly adopted, adapted and extended into most health care settings in Australia. [46][47][48] …”

Section: Resultsmentioning

confidence: 99%

“…47 The model has been described as conforming to the highest standards of clinical governance, which would provide hospital board-level reassurance around clinical governance structures. 47 There is also evidence that use of the proposed model at the trainee level helps to produce long-term beneficial, transformational, cultural change that leads to continued use of performance-monitoring tools.…”

Section: To Hospitalsmentioning

confidence: 99%

“…However, emerging evidence suggests that precisely this type of cultural change is being achieved in ANZCA-accredited trainees (Australian and New Zealand College of Anaesthetists) in Australia using portable digital technology. 41,[46][47][48] 46 This has led to a documented 98% incident reporting rate in ANZCA trainees. 48 The incidents are reported by single screen touches to a drop down menu of 8 possible categories of incident with subclassification of each major incident reporting type.…”

Section: The Problem In Health Carementioning

confidence: 99%

“…Although there is a cost for annual subscription, we conclude that the benefits outlined above outweigh the costs. 47 The Federal Department of Trade and Industry has expressed confidence in the sustainability of the model through their recent decision to award a $0.53 million grant to the software authors of the PDA programme (DTI Grant Reference Number GRA03204; Project Name: Medical Incident Management and Procedure Collaboration). This funding is to develop the rest of the medical speciality programmes for the PDA to allow data collection in all areas of medical practice.…”

Section: Colleges and Specialist Associationsmentioning

confidence: 99%

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Using portable digital technology for clinical care and critical incidents: a new model

Bolsin

Faunce²,

Colson³

2005

Aust. Health Review

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The number of patients suffering adverse incidents during treatment in hospitals is not declining. The cost of this poor safety record in Australia is $1 billion to $4.7 billion each year. Quality and safety initiatives focus on promoting adverse event reporting. Major problems include poor reporting of adverse events and lack of clinician involvement.We propose a model for clinician-led reporting based on secure transmission of encrypted data from a programmed personal digital assistant (PDA) to a secure database, leading to automated analysis of clinician-performance data. The programmed PDA also facilitates the reporting of critical incidents. All critical incidents are automatically fed back by email to the organisational The problem in health careThe available evidence suggests that the percentage of hospitalised patients suffering an adverse incident during admission is not declining. 1-5Major inquiries into publicised revelations of substandard health care performance continue to find one of the major contributing factors is an institutional and professional culture opposed to self-reporting and open disclosure.6-10 The costs of this continuing poor safety record run to billions of dollars in most developed societies. 1,5,11 Current quality and safety initiatives focus on promoting adverse or sentinel incident reporting to institutional committees seeking to discover contributory causes and implement corrective strategies 1,12,13 Unfortunately, poor individual reporting rates for adverse events in health care and inadequate clinician involvement in the related processes continue. 1,[14][15][16][17][18] This is despite other industries, such as aviation and environmental resource management, making considerable progress in this area. 19,20 The adoption of sustained health care quality improvement programs is similarly poor despite the fact that numerous authors have documented the benefits of such programmes to improved What is known about the topic? New information technologies promise to make meaningful, accurate data about patient care broadly available, and the potential advantages for quality and safety have long been anticipated. Realising those benefits has been a difficult and slow process. What does this paper add?A system which enables anaesthetists to record routine clinical data, and critical incidents, by means of hand-held computers has been successfully introduced in three major hospitals, with good results. Careful attention to the ownership and security of data, and the questions of cost and indemnity have been critical to the success of this model. What are the implications?Direct input of clinical data by clinicians at the point of care is practically and financially feasible, and professionally acceptable, in at least some settings, and offers significant potential benefits for the safety and quality of patient care.

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Section: Resultsmentioning

confidence: 99%

Section: To Hospitalsmentioning

confidence: 99%

Section: The Problem In Health Carementioning

confidence: 99%

Section: Colleges and Specialist Associationsmentioning

confidence: 99%

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Using portable digital technology for clinical care and critical incidents: a new model

Bolsin

Faunce²,

Colson³

2005

Aust. Health Review

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“…Similarly, few evaluative studies of personal professional monitoring programmes for anaesthetists or trainees exist. 12,13 Perioperative quality indicators…”

Section: Chapter 3 Background Research and Theorymentioning

confidence: 99%

Evaluation of a continuous monitoring and feedback initiative to improve quality of anaesthetic care: a mixed-methods quasi-experimental study

Benn

Arnold

D’Lima

et al. 2015

Health Serv Deliv Res

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BackgroundThis study evaluated the impact of a continuous quality monitoring and feedback initiative in anaesthesia.ObjectivesTo conduct a quasi-experimental evaluation of the feedback initiative and its effect on quality of anaesthetic care and perioperative efficiency. To understand the longitudinal effects of passive and active feedback and investigate the mechanisms and interactions underpinning those effects.DesignMixed-methods evaluation with analysis and synthesis of data from longitudinal qualitative interviews, longitudinal evaluative surveys and an interrupted time series study.InterventionContinuous measurement of a range of anaesthetic quality indicators was undertaken in a London teaching hospital alongside monthly personal feedback from case summary data to a cohort of anaesthetists, with follow-up roll-out to the whole NHS trust. Basic feedback consisted of the provision of passive monthly personalised feedback reports containing summary case data. In the enhanced phase, data feedback consisted of more sophisticated statistical breakdown of data, comparative and longitudinal views, and was paired with an active programme of dissemination and professional engagement.MethodsBaseline data collection began in March 2010. Implementation of basic feedback took place in October 2010, followed by implementation of the enhanced feedback protocol in July 2012. Weekly aggregated quality indicator data, coupled with surgical site infection and mortality rates, was modelled using interrupted time series analyses. The study anaesthetist cohort comprised 50,235 cases, performed by 44 anaesthetists over the course of the study, with 22,670 cases performed at the primary site. Anaesthetist responses to the surveys were collected pre and post implementation of feedback at all three sites in parallel with qualitative investigation. Seventy anaesthetists completed the survey at one or more time points and 35 health-care professionals, including 24 anaesthetists, were interviewed across two time points.ResultsResults from the time series analysis of longitudinal variation in perioperative indicators did not support the hypothesis that implementation of basic feedback improved quality of anaesthetic care. The implementation of enhanced feedback was found to have a significant positive impact on two postoperative pain measures, nurse-recorded freedom from nausea, mean patient temperature on arrival in recovery and Quality of Recovery Scale scores. Analysis of survey data demonstrated that anaesthetists value perceived credibility of data and local relevance of quality indicators above other criteria when assessing utility of feedback. A significant improvement in the perceived value of quality indicators, feedback, data use and overall effectiveness was observed between baseline and implementation of feedback at the primary site, a finding replicated at the two secondary sites. Findings from the qualitative research elucidated processes of interaction between context, intervention and user, demonstrating a positive response by clinicians to this type of initiative and willingness to interact with a sustained and comprehensive feedback protocol to understand variations in care.ConclusionsThe results support the potential of quality monitoring and feedback interventions as quality improvement mechanisms and provide insight into the positive response of clinicians to this type of initiative, including documentation of the experiences of anaesthetists that participated as users and codesigners of the feedback. Future work in this area might usefully investigate how this type of intervention may be transferred to other areas of clinical practice and further explore interactions between local context and the successful implementation of quality monitoring and feedback systems.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Mitochondrial Function and Dysfunction Within the Optic Nerve

Sadun¹,

Carelli²

2003

Arch Ophthalmol

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The value of personal professional monitoring performance data and open disclosure policies in anaesthetic practice: a case report

Cited by 15 publications

References 10 publications

Using portable digital technology for clinical care and critical incidents: a new model

Using portable digital technology for clinical care and critical incidents: a new model

Evaluation of a continuous monitoring and feedback initiative to improve quality of anaesthetic care: a mixed-methods quasi-experimental study

Mitochondrial Function and Dysfunction Within the Optic Nerve

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