Making a difference: the Anesthesia Quality Institute.

The theme of this issue of Anesthesia & Analgesia is “anesthesiologists make a difference.” This is the inescapable conclusion of the demonstration by Glance et al.1 that the choice of anesthesiologist has a significant impact on outcome in cardiac surgery. Accompanying editorials by Maxwell et al.,2 Wijeysundera and Beattie,3 and Leslie and Merry4 explore how we should interpret this finding. We see this every day in practice: a skilled anesthesiologist makes a difference in clinical outcomes, but here we have tangible proof. However, there is a bigger picture to consider. Glance et al. made a difference just by asking the question. It is important to know whether training, experience, and clinical acumen matter. As scientific physicians, we ask and answer important questions. We have done that for nearly a century, as evidenced by our journals. As a profession, we make a contribution by gathering the data to see what improves outcome, what does not improve outcome, and what we can do better in the future. I am the director of the Anesthesia Quality Institute (AQI), part of our profession’s effort to make a difference. The AQI is a new initiative, barely 5 years old. However, the AQI is already making a difference in practice. The AQI provides anesthesiologists with the ability to examine their professional experience and make rational improvements. The AQI will be another lever that enables us to move the world, one of the biggest levers available to us. The AQI was created by a resolution of the American Society of Anesthesiologists (ASA) House of Delegates in October 2008. The House appointed a Board of Directors, approved bylaws and appropriated funding for an organization “To become the primary source for quality improvement in the clinical practice of anesthesiology.” While quality improvement is a concept as old as the specialty, the mission of the AQI was to apply the most advanced tools of the Information Age. The ability to readily access, transmit, and store digital information about every anesthesia patient and every procedure created the opportunity to learn about our specialty in a new and powerful way. For the founding fathers of the AQI, this capability was a professional imperative: if it could be done, it must be done. With ASA’s ongoing commitment, the AQI has developed rapidly. The first cases entered the National Anesthesia Clinical Outcomes Registry (NACOR) shortly after its “birthday” on January 1, 2010. More than 22 million cases have followed.