Background and Goal of Study: Anaesthetists rarely receive systematic feedback on their patients' experience of recovery in the immediate post operative period. Sustained, frequent and specific performance feedback has been shown to stimulate quality improvement but the specific mechanisms of effect are not well understood. This study aimed to evaluate an initiative at St Mary's Hospital, London, to monitor and provide continuous personalised feedback to anaesthetists on quality of recovery from surgery.
Materials and Methods: In March 2010, data collection on quality of recovery, pain, emesis, and ward waiting time commenced in the recovery unit. All elective surgical patients were included. Monthly, personalised reports for anaesthetists and departments were implemented in September 2010. These compromised anonymous data, in longitudinal and cross-sectional formats, personalised for each individual anaesthetist's case load.To investigate acceptability and usefulness of the initiative, an evaluative survey was developed and administered pre and post implementation to a cohort of 32 anaesthetists. Items addressed the perceived reliability, comprehensiveness, timeliness and credibility of feedback using 8-point response scales. Statistical results were analysed using repeated measures t-tests (significance level p< 0.01).
Results and Discussion: Piloting and development of the survey achieved high scale reliability (Alpha > 0.8). Comparison of time points revealed pronounced effects on local perceptions of quality monitoring and feedback. Significant increments in mean scores between time points was observed for quality indicator adequacy (mean change 3.55; t = -6.83, p< 0.01), feedback effectiveness (4.22; t = -6.94, p< 0.01), and constructive data use (2.93; t = -4.68, p< 0.01). The initiative had a mixed effect upon local workplace climate. Anaesthetists reported improvement in the department's capacity to demonstrate compliance with best practice and the ability to use personal performance data constructively.
Conclusion(s): This initiative showed that it is possible to define and implement relevant, reliable and credible quality indicators for patient recovery; providing useful feedback to anaesthetists. Potential applications of this initiative include supporting clinician revalidation in the UK.