Quality Assurance Instruments: Applications for the OR
Quality Assurance, also known in the Operations Management realm dialogue as QA, is of the utmost importance in surgical and anesthesia care. In the operating room, every second counts and can make a difference in the patient succeeding in recovery to full form. For anesthesiologists, QA is similarly important, as each agent must be precisely delivered in order to provide optimal perioperative care. In continuing to meet QA objectives in hospitals across the country, it is useful to consider recent research that provides a lens for tools and practices to improve QA. In this way, research-driven practices can inform care across the country, and ensure that anesthesiologists and surgeons alike are performing to the highest of their abilities.
The conventional method of quality assurance involves high-volume data input, predominantly based on series of indicators as per national quality in healthcare organizations. Despite the availability of non-profits such as the Joint Commission, which accredits hospitals and clinical centers in the United States based on universal quality assurance and other indicators, there still remains a large variety in terms of how each individual health provider collects data on QA. In addition, data that is left unanalyzed provides no practical application in terms of modifying practices in order to affect patient outcomes. Hence, novel approaches are needed in order to provide a universal, research-driven set of indicators for quality assurance, as well as to provide a vehicle by which to link data with results.
In response to this global need, researchers recently concluded a study examining the efficacy of a tactfully designed QA instrument for use in the operating room[1]. The instrument is a dynamic, multi-dimensional tool that collects multiple data streams including socioeconomic demographics, professional attributes, and specific line items that discuss internal audits, number of complications, and wait times among others. The instrument was delivered to physicians, and validated using statistical methods. It was calculated that this instrument effectively reflected three dimensions, which included process evaluation, quality of care assessment, and control systems. In an application setting, the instrument also provided areas of opportunity for administrative and clinical managers to identify areas of improvement in the quality assurance pipeline, and deliver said interventions. The results of this study are encouraging with regards to the development of instruments that may be shared across operating rooms. However, advocacy is also essential in order to share technical knowledge and ensure that QA remains a priority for hospitals and healthcare centers.
Although
the foundation of QA is strong, the lack of universal adherence warrants a
modernized approach. Multi-pronged instruments represent an opportunity for
change, and can be built upon with the guidance of experienced clinicians,
including anesthesiologists, in tandem with skilled organizations. Elucidating
specific and tailored indicators for quality assurance, from the time a patient
is entered into the system to the point of discharge, is essential for
promoting high-quality care through the perioperative cycle. QA as a sub-field
of Operations Management is thus a significant topic area for anesthesia and
surgical services, ripe with possibility for research, interventions, and
practice.
[1] Gomes, José Augusto Pereira, et al. “Validation of an Instrument to Measure the Results of Quality Assurance in the Operating Room.” Quality Management in Health Care, vol. 28, no. 2, 2019, pp. 103–107., doi:10.1097/qmh.0000000000000205.