Pre- and Post-Anesthesia Assessment: Role of the AQI
Electronic capture of patient information before and after surgery is an essential component of an effective anesthesia quality management program.
- Postoperative data are the outcomes of our work. These include rare safety issues related to intraoperative care, but not always apparent in the OR or PACU: events like neurologic injury, myocardial infarction, aspiration pneumonia or complications of pain management. More common, and increasing in importance, are the “patient-centered” outcomes which will be used by external regulators to judge us: the occurrence of nausea and vomiting, the adequacy of pain management, and overall patient satisfaction.
- Preoperative information, on the other hand, is the substrate for understanding anesthesia risks. Comparison of outcomes across institutions will require careful risk adjustment, and electronic capture of pre-existing conditions, chronic medications and pertinent diagnostic studies will enable this process. Even information as simple as the ASA physical status can be a powerful tool for understanding anesthesia outcomes across broad populations.
As proprietor of the National Anesthesia Clinical Outcomes Registry, the Anesthesia Quality Institute is a strong proponent of electronic data capture in all phases of anesthesia care. The more practices can make preoperative and postoperative data available, the sooner we will have robust national benchmarks for anesthesia performance. The good news is that there are a number of companies and products emerging to fill this need, as well as a variety of innovative solutions. Many vendors of Anesthesia Information Management Systems (AIMS) have been offering PACU record keeping for years, often including a Quality Management form to capture outcomes and complications. Many of these forms now follow the categories and definitions established by the ASA Committee on Performance and Outcome Measures, and freely available on the AQI website (www.aqihq.org). The 26 adverse outcomes established by this committee appear in Table 1. A sample definition from the same committee report is in Figure 1.
The more foresighted AIMS vendors are expanding even further, to include modules that can be used by anesthesiologists and their facilities to record post-discharge follow-up. Traditional barriers to this effort are slowly eroding. Concern with legal discovery has led to systems that route QM forms to a different database from the AIMS medical record; the need to submit requests for reimbursement promptly has led to partition of postoperative records within the global EMR, so that the case can still be “closed out” in a timely fashion. And the difficulty of interfacing the AIMS with the institutional EMR is moderating with the general growth in interoperability across healthcare information technology, and with the evolution of local data repositories that aggregate information from multiple platforms.
For practices not yet using an AIMS, there now exist a variety of stand-alone preoperative and postoperative data capture systems. Notable among these is ePreop, which draws on the AQI schema and definitions to provide a “one-stop shop” for coordinating the care of perioperative patients. ePreop software now extends to cover the capture of outcome and satisfaction information as well. Other programs, such as Fides, are designed to make it easy to enter patient feedback from postoperative phone calls into a database that links to the original case. No one technical solution will be right for every practice situation, but it is encouraging that software now exists to enable the basic steps of: 1) gathering outcomes from patients, 2) linking those outcomes to records of the surgery itself, and 3) reporting that data in digital form on both the local and national level.
Every anesthesia practice needs to understand the outcomes it achieves, and that AQI exists to aggregate those outcomes and create national benchmarks. Eighty-three percent of AQI participants collect and report some outcomes from their cases, and already benefit from an improved understanding of their own practice. ABC and ePreop are committed to facilitating this advance in care, and to the general improvement of safety.