Longnecker's Anesthesiology > Part 3. Safety and Risk Reduction in Anesthesia Practice > Chapter 25. Approaches to Quality Improvement in Anesthesia Care David S. Smith, MD, PhD, and Lee A. Fleisher, MD

Key Points

"1. There is significant public dissatisfaction with the level of safety associated with medical care in the United States. This issue has been taken up by many legislative and governmental regulatory bodies at both federal and state level.

2. The demand for greater patient safety (i.e., error reduction) has created multiple new levels of regulation and demands for accountability that go well beyond the traditional.

3. The traditional approach of practitioner accountability is giving way to approaches that additionally emphasize systems redesign and group managed processes.

4. The demands for accountability requires that individual practitioners, groups of practitioners, hospitals, and entire health systems implement methods that allow documentation of outcome and process.

5. Relying on review systems such as the case conference and focusing on the individual patient is inadequate for the level of error remediation demanded. New approaches that allow examination of aggregate performance across a hospital or health system need to be developed and implemented. This is particularly challenging for perioperative anesthesia care considering the already low level of adverse outcomes.

6. For many practitioners, reimbursement in the future will be linked to both outcome and demonstrated compliance with process variables such as perioperative antibiotic..."