Measuring and recording outcome.

Achieving good health outcomes for patients is the fundamental purpose of healthcare. What really matters to patients is the outcome of an intervention and the effect it will have on their wellbeing and life expectancy. After media coverage, and public enquiry into high mortality rates for paediatric cardiac surgery at the Bristol Royal Infirmary during the early 1990s, mortality rates for paediatric cardiac surgical procedures decreased dramatically both in Bristol and nationally. There can be little doubt that one of the prime 'drivers for change' was the placement of outcome data into the public domain. After events in Bristol, the Society for Cardiothoracic Surgery in Britain and Ireland (SCTS) has taken the lead in measuring and publishing clinical outcome data. It has also discussed how outcome data could be used to assess an individual's clinical performance and how, in the future, this might be linked to continuing professional development, appraisal, and revalidation. Measuring quality and outcome in healthcare is complex. Ideal outcome measures should be specific, sensitive, reliable, responsive, validated, timely, and easy to measure. Monitoring of outcomes can be 'process' orientated or 'clinically' orientated. The 2010 National Health Service (NHS) White Paper aimed for an NHS which 'moves away from centrally driven process targets and focuses on delivering outcomes which matter to people'. Measuring outcome in anaesthesia is problematic. There are issues around clinical coding, risk adjustment, the influence of clinical teamworking, and environmental factors. The National Institute of Academic Anaesthesia (NIAA) has identified that the description of clinical practice in anaesthesia and perioperative medicine is currently limited by a lack of valid, reliable quality measures. The NIAA suggests that there is a requirement for further research into identifying the anaesthetic outcome indicators which are most relevant to patients, and then benchmarking the performance of anaesthetic departments and anaesthetists.