Abstract
BackgroundIn 2016 the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthetists (BDA) published 10 quality indicators (QI) to compare and improve the quality of anesthesia care in Germany. So far, there is no evidence for the feasibility of implementation of these QI in hospitals.ObjectiveThis study tested the hypothesis that the implementation of the 10 QI is feasible in German hospitals.Material and methodsThis prospective three-phase national multicenter quality improvement study was conducted in 15 German hospitals and 1 outpatient anesthesia center from March 2017 to February 2018. The trial consisted of an initial evaluation of pre-existing structures and processes by the heads of the participating anesthesia departments, followed by a 6-month implementation phase of the QI as well as a final re-evaluation phase. The implementation procedure was supported by web-based implementation aids (www.qi-an.org) and internal quality management programs. The primary endpoint was the difference in the number of implemented QI per center before and after implementation. Secondary endpoints were the number of newly implemented QI per center, the overall number of successful implementations of each QI, the identification of problems during the implementation as well as the kind of impediments preventing the QI implementation.ResultsThe average number of implemented QI increased from 5.8 to 6.8 (mean of the differences 1.1 ± 1.3; P < 0.01). Most frequently the QI perioperative morbidity and mortality report (5 centers) and the QI temperature management (4 centers) could be implemented. After the implementation phase, the QI incidence management and patient blood management were implemented in all 16 centers. Implementation of other quality indicators failed mainly due to a lack of time and lack of structural resources.ConclusionIn this study the implementation of QI was proven to be mostly feasible in the participating German hospitals. Although several QI could be implemented with minor effort, more time, financial and structural resources would be required for some QI, such as the QI postoperative visit.
Highlights
The quality of anesthesia is affected by an array of factors
Implementation of quality indicators (QI) II failed, since the anesthesia protocol used by the center is standardized for participation in the Perioperative Medicine Network (PoMNet) which would interfere with the Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) recommendations
The aim was to determine whether intraoperative body temperature was measured and the corresponding temperature value at the end of the surgery as well as completion rates required by QI VI and VII
Summary
The quality of anesthesia is affected by an array of factors. These include patientcentered variables, such as patient safetyPreliminary data of this study were presented at the Deutsche Anästhesiecongress (DAC), 9–11 May 2019, Leipzig, Germany. These factors can be subsumed into three categories: first, the quality of the institution’s structure, second, the quality of the anesthesia process itself and third, the quality of the outcome and its measurability [5]. This study tested the hypothesis that the implementation of the 10 QI is feasible in German hospitals. This prospective three-phase national multicenter quality improvement study was conducted in 15 German hospitals and 1 outpatient anesthesia center from March 2017 to February 2018. The trial consisted of an initial evaluation of pre-existing structures and processes by the heads of the participating anesthesia departments, followed by a 6-
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