Evidence-based Practice and Quality Improvement
Background: Anaesthesia has made great strides in establishing and maintaining standards of safety and quality. There is, however, no national standard for measuring quality in Anaesthesia in the UK. We devised a set of 9 quality indicators and used them to audit local practice.
Method: The following indicators were used to audit 3817 sets of patient notes. Patient demographics (gender, age, ASA Grade and urgency) were also collected.
- Pre-operative visit on day of surgery?
- Anaesthetic time?
- Documentation of minimum standards of Association of Anaesthetists of Great Britain and Ireland (AAGBI) monitoring? (pulse oximetry, blood pressure, ECG, vapour, FiO2, ETCO2 & airway pressure)
- Handover to recovery?
- Critical incident in recovery?
- Any unplanned overnight admission?
- Any unplanned admission to ICU?
- Time spent in recovery?
- Over 2 hours in recovery?
Results: Patient demographics showed variability believed to be representative of most District General Hospitals.
- 273 (7.2%) patients not seen by an anaesthetist
- Median anaesthetic time of 12 minutes (range 1-120, IQR 14)
- 1538 (40.4%) did not have monitoring documented to AAGBI standards
- 1104 (29%) patients not handed over to recovery
- 5 patients (0.13%) suffered a critical incident
- 10 patients had an unplanned overnight admission
- 16 patients had an unplanned admission to ICU
- Median recovery time of 38 minutes (range 1-1519, IQR 34)
- 97 (2.55%) patients had a recovery stay >2 hours.
Discussion: There is no UK national standard to compare our results to. Some can be compared to AAGBI standards, others can only be reported and put into context.
The audit found several areas where practice could be improved. Particularly, 7.2% of patients were not seen pre-operatively, 40.4% had inadequate documentation of monitoring and 29% were not handed over to recovery.
Conclusion: This audit of quality indicators showed several areas where local practice could be improved. The quality indicators would be suitable for use in most UK anaesthetic departments.
1. Recommendations for standards of monitoring during anaesthesia and recovery; 4th
Edition; AAGBI; March 2007.
2. Good Medical Practice; GMC; November 2006.