Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
Department of Anesthesiology, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA.
Mil Med. 2021 Aug 28;186(9-10):1001-1009. doi: 10.1093/milmed/usab051.
Tracking measures of quality over time has been shown to improve care within institutions and across health systems. Perioperative quality assurance (QA) tracking by anesthesia departments in the Military Health System (MHS) has not used a uniform system integrated into the workflow of anesthesia providers. The purpose of this study was to demonstrate that the use of the embedded QA outcome reporting feature in the anesthesia information management system (AIMS) increased the rate of reporting compared to the current paper reporting system in a military anesthesia department.
An electronic outcome reporting mechanism embedded in the AIMS was activated as an alternative to paper QA outcome reporting. The proportion of anesthesia cases per month in a 12-month period with a reported QA outcome was compared to the previous year in which only the paper reporting system was used. The total number of cases in each time period with an outcome reported was compared using chi square for proportions, and systems were evaluated using the Statistical Process Control methodology. This project was evaluated and determined to be exempt from review by our institutional review board.
There was a 389.8% increase in the number of cases with a QA outcome reported after the implementation of the outcome reporting function integrated into the AIMS (χ2 = 207.72; P <.001, Table I). Systems before and after the intervention were stable, and special cause variation was noted only at the point of implementation of the electronic reporting system. Anesthesia providers were surveyed and felt that the addition of QA reporting to the AIMS made QA reporting more likely.
The use of an electronic QA outcome reporting method integrated into the AIMS dramatically increased the likelihood that a QA outcome would be reported. The decreased administrative burden of the integrated outcome reporting system was likely the primary reason for this increase. This study was limited by the fact that it was done in a single institution; however, the size and timing of the increase clearly indicate that the intervention was the reason for improved reporting. Electronic health record upgrades should consider incorporating QA reporting into the AIMS across the MHS. These measures could allow for system-wide improvement, evaluation, and evidence-based education on their own, but also by facilitating participation in the American Society of Anesthesiologists' Anesthesia Quality Institute's National Anesthesia Clinical Outcomes Registry. This report serves as a valuable example to institutions and perioperative leaders in the MHS of how to improve the robustness of perioperative QA reporting such that it could be used to validate and improve the value of care.
跟踪一段时间内的质量指标已被证明可以改善机构内和整个卫生系统的护理。军事卫生系统（MHS）的麻醉部门的围手术期质量保证（QA）跟踪尚未使用集成到麻醉提供者工作流程中的统一系统。本研究的目的是证明在军事麻醉部门中，使用麻醉信息管理系统（AIMS）中嵌入的 QA 结果报告功能可以提高报告率，与当前的纸质 QA 结果报告系统相比。
在 AIMS 中激活了一个电子结果报告机制，作为纸质 QA 结果报告的替代方法。将 12 个月内每月报告 QA 结果的麻醉病例比例与仅使用纸质报告系统的前一年进行比较。使用卡方检验比较每个时间段内报告结果的病例总数，并使用统计过程控制方法评估系统。该项目经过评估，被确定为我们的机构审查委员会无需审查。
在将集成到 AIMS 中的结果报告功能实施后，报告 QA 结果的病例数量增加了 389.8%（χ2=207.72；P<.001，表 I）。干预前后的系统均稳定，仅在实施电子报告系统时出现特殊原因变化。对麻醉提供者进行了调查，他们认为将 QA 报告添加到 AIMS 中更有可能进行 QA 报告。
使用集成到 AIMS 中的电子 QA 结果报告方法极大地增加了报告 QA 结果的可能性。集成结果报告系统减少了行政负担，这可能是报告增加的主要原因。本研究的局限性在于它是在单个机构进行的；然而，增加的规模和时间清楚地表明，干预是提高报告率的原因。电子健康记录升级应考虑在整个 MHS 中将 QA 报告纳入 AIMS。这些措施不仅可以自行进行系统范围的改进、评估和基于证据的教育，还可以通过促进参与美国麻醉师协会的麻醉质量研究所的国家麻醉临床结果登记处来实现。本报告为 MHS 中的机构和围手术期领导者提供了一个有价值的示例，说明了如何提高围手术期 QA 报告的稳健性，以便可以将其用于验证和提高护理的价值。
