Macario A, Weinger M, Truong P, Lee M
Department of Anesthesia, Stanford University Medical Center, California 94305-5640, USA.
Anesth Analg. 1999 May;88(5):1085-91. doi: 10.1097/00000539-199905000-00023.
Anesthesia groups may need to determine which clinical anesthesia outcomes to track as part of quality improvement efforts. The goal of this study was to poll a panel of expert anesthesiologists to determine which clinical anesthesia outcomes associated with routine outpatient surgery were judged to occur frequently and to be important to avoid. Outcomes scoring highly in both scales could then be prioritized for measurement and improvement in ambulatory clinical practice. A mailed survey instrument instructed panel members to rate 33 clinical anesthesia outcomes in two scales: how frequently they believe the outcomes occur and which outcomes they expect patients find important to avoid. A feedback process (Delphi process) was used to gain consensus rankings of the outcomes for each scale. Importance and frequency scores were then weighted equally to qualitatively rank order the outcomes. Of the 72 anesthesiologists, 56 (78%) completed the questionnaire. The five items with the highest combined score were (in order): incisional pain, nausea, vomiting, preoperative anxiety, and discomfort from IV insertion. To increase quality of care, reducing the incidence and severity of these outcomes should be prioritized.
Expert anesthesiologists reached a consensus on which low-morbidity clinical outcomes are common and important to the patient. The outcomes identified may be reasonable choices to be monitored as part of ambulatory anesthesia clinical quality improvement efforts.
麻醉团队可能需要确定在质量改进工作中应追踪哪些临床麻醉结果。本研究的目的是对一组麻醉专家进行调查，以确定与常规门诊手术相关的哪些临床麻醉结果被认为经常发生且对避免发生很重要。在这两个量表中得分都很高的结果随后可被列为门诊临床实践中测量和改进的优先事项。一份邮寄的调查问卷要求专家组成员对33项临床麻醉结果在两个量表上进行评分：他们认为这些结果发生的频率以及他们认为患者会觉得哪些结果对避免发生很重要。采用反馈过程（德尔菲法）来获得每个量表上结果的共识排名。然后将重要性和频率得分同等加权，以对结果进行定性排序。在72名麻醉医生中，56名（78%）完成了问卷。综合得分最高的五个项目依次为：切口疼痛、恶心、呕吐、术前焦虑和静脉穿刺不适。为提高护理质量，应优先降低这些结果的发生率和严重程度。
麻醉专家就哪些低发病率的临床结果对患者来说常见且重要达成了共识。确定的这些结果可能是作为门诊麻醉临床质量改进工作一部分进行监测的合理选择。
