Title: A Comparative Study of Key Quality Performance Indicators in Anaesthesia and Surgery, between the Years 2013 and 2014, in Operation Theatre at Indian Spinal Injuries Centre, New Delhi
Authors: Dr H.K.Mahajan, Dr Ravinder Dhanerwa, Dr P.R.Chauhan, Dr Abhinav Gupta
DOI: https://dx.doi.org/10.18535/jmscr/v5i2.07
Abstract
Introduction: Quality and safety indicators are used to measure and monitor the quality of the services provided to the patients. It encourages an environment of continuous and sustained quality. Clinical indicators in Anaesthesia were first drafted by the United States Joint Commission on Hospital accreditation in 1992. They were included as a part of accreditation process for hospitals in Australian council in Health care standards in 1993.In India in 2006, NABH was established with the objective of enhancing health system and promoting continous quality improvement and patient safety. It has full functional autonomy in its operation. NABH is a member of ISQua accreditation council. The approval of ISQua authenticates that NABH standards are in consonance with the global benchmarks.
Aim: The present study aims to have an assessment of anaesthesia and surgical services at a tertiary level Healthcare standard as given by National Accreditation Board for Hospitals and Health Care.
Objectives
1. To analyse the performance of CQI of Anaesthesia and surgical services in the years 2013 and 2014, in line NABH.
2. To identify gaps and suggest improvements in Anaesthesia and surgical services.
Methodology: It is a retrospective study of key quality indicators, (CQI-NABH) with respect to anaesthesia and surgical services at Indian Spinal Injuries Centre. It is as per COP 13 and COP 14 and CQI.3 standards of NABH 3rd edition 2011. The data for the study was taken from patient records like anaesthesia notes, surgical notes and WHO surgical check safety check list for each patient in the medical record department and from anaesthesia, surgical register in the operation theatre and OT scheduling register available with the OT manager.
Statistical Analysis: Data was analysed using average percentage method and MS excel to draw the conclusions.
Results: The percentage modification of Anaesthesia plan, unplanned ventilation following anaesthesia, adverse anaesthesia events was less than 1% in both the years and there was no anaesthesia related mortality.
Compliance with the WHO surgical safety checklist improved to 98% from 85%. No case of wrong surgery, wrong patient or wrong site was reported. But rescheduling increased to 3% from 0.6%. Results were in line with the NABH.
Recommendations: Recommendations have been made to the management to further streamline the OT functions and to ensure 100% compliance of NABH standards.
References
1. Axel Fudickar, Kim Horie, Jorg Witfang, Berthold, The effect of WHO safety check list on complication rate and commun-ication Deutsches Arzteblatt International/ dtsch Arztebl Int 2012; 695-701
2. Heather C Kaplan, W. Brady, The influence of context on quality improvement success in health care88. P 5, The Milbank Quarterly, 88 p. 500-559
3. Satyawan AB, Audit of intensive care admissions from the operating room. Indian J Anaes 2006, 50(3): 193-200
4. Pederson, A prospective study of mortality associated with anaesthesia and surgery: risk indicators of mortality in hospital. Acta Anaesthesiol Scand 1990; 34: 176-82
5. J Benn, Using quality indicators in anaesthesia: feeding back data to improve care, British Journal of Anaesthesia 2012 p 1-12
6. Times of India, Accreditation results in high quality care and patient safety, The Times of India, July 19,2005 p 5
7. Anaesthesia text book by Ronald d. Miller, Human performance and patient safety. 7th edition, P. 93-143
8. James Kindscher, Operating room management, Miller’s Anaesthesia text book, 7th edition p. 3023-3036
9. National Accreditation Board for Hospitals and Health Care Providers, 3rd edition, November 2011
10. Elizabeth Travis, operation theatre timing where does it all go? A prospective observational study. Br Med J 2014; 2014:g7182
11. Royal college of Anaesthetist: Raising the standards; A compendium of Audit recipes-3rd edition 2012.
12. Guy Haller et al, Quality and Safety Indicators in Anaesthesia: A systematic review, Anesthesiology 2009;110:1158-75