Department of Anesthesia and Pain Medicine, The Hospital for Sick Children (SickKids), 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2024 Jul;71(7):944-957. doi: 10.1007/s12630-024-02763-9. Epub 2024 May 9.
In this project, we sought to develop and implement pediatric anesthesia metrics into electronic health records (EHR) in a hospital setting to improve quality and safety of patient care. While there has been an upsurge in metric-driven health care, specific metrics catering to pediatric anesthesia remain lacking despite widespread use of EHR. The rapid proliferation and implementation of EHR presents opportunities to develop and implement metrics appropriate to local patient care, in this case pediatric anesthesia, with the strategic goal of enhancing quality and safety of patient care, while also delivering transparency in reporting of such metrics.
Using a quasi-nominal consensus group design, we collected requirements from attending anesthesiologists using Agile methodology. Forty-five metrics addressing quality of care (e.g., induction experience, anesthesia delivery, unanticipated events, and postanesthetic care unit stay) and provider performance (e.g., bundle-compliance, collaboration, skills assurance) were developed. Implementation involved integration into the EHR followed by transition from PDF-based feedback to interactive Power BI (Microsoft Corporation, Redmond, WA, USA) dashboards.
We introduced and implemented customized pediatric anesthesia metrics within an academic pediatric hospital; however, this framework is easily adaptable across multiple clinical specialties and institutions. In harnessing data-collecting and reporting properties of EHR, the metrics we describe provide insights that facilitate real-time monitoring and foster a culture of continuous learning in line with strategic goals of high-reliability organizations.
在本项目中，我们旨在开发并将儿科麻醉指标纳入医院电子病历（EHR）系统，以提高患者护理质量和安全性。尽管 EHR 的使用已普及，但针对儿科麻醉的具体指标仍显缺乏，而医疗保健领域的指标驱动正日益兴起。EHR 的快速普及和应用为开发和实施适用于当地患者护理的指标提供了机会，就本案例中的儿科麻醉而言，这一战略目标是提高患者护理质量和安全性，同时报告此类指标时也保持透明度。
我们采用准名义共识小组设计，使用敏捷方法从主治麻醉师那里收集需求。制定了 45 项指标，涵盖了护理质量（如诱导体验、麻醉实施、意外事件和麻醉后恢复室停留时间）和提供者绩效（如方案依从性、协作、技能保证）。实施包括将指标整合到 EHR 中，然后从基于 PDF 的反馈过渡到交互式 Power BI（Microsoft Corporation，Redmond，WA，USA）仪表板。
我们在一家学术型儿科医院引入并实施了定制化的儿科麻醉指标；然而，这个框架很容易适应于多个临床专业和机构。通过利用 EHR 的数据收集和报告功能，我们描述的这些指标提供了有助于实时监测的见解，并培养了与高可靠性组织的战略目标一致的持续学习文化。
