Building a large-scale perioperative anaesthesia outcome-tracking database: methodology, implementation, and experiences from one provider within the German quality project.

The German Society of Anaesthesiology and Intensive Care Medicine evaluates voluntary, standardized, everyday, perioperative anaesthesia outcome measures. A standard minimal data set is collected for national benchmarking. This article reviews the implementation of a data acquisition system in one academic centre that has participated in this long-term nationwide project since its initiation in 1992. The population studied comprised 96,107 patients up to 1997. The overall incidence of anaesthesia-related incidents, events and complications (IEC) was 22%. Results are presented and discussed for 63 different IEC, seven functional system categories and five severity grades. The proposed methodology, using computer-readable records, was suitable for comprehensive and detailed outcome documentation. However, an extensive data validation system was necessary. IEC reporting results were largely dependent on the documentation culture. The future of outcome tracking in routine anaesthesia may lie in multicentre comparisons with multivariate-adjusted risk and comorbidity data from each provider's integrated information system.

[1]  M. Cohen,et al.  A survey of 112,000 anaesthetics at one teaching hospital (1975–83) , 1986, Canadian Anaesthetists' Society journal.

[2]  Karen B. Domino,et al.  Multicenter study of general anesthesia. II. Results. , 1990 .

[3]  T. Kersting Qualitätssicherung und Qualitätskontrolle in der Anästhesie , 1991 .

[4]  D M Berwick,et al.  Controlling Variation in Health Care: A Consultation from Walter Shewhart , 1991, Medical care.

[5]  J P Jayasuriya,et al.  Compliance with an incident report scheme in anaesthesia , 1995, Anaesthesia.

[6]  S. Arvidsson,et al.  The Gothenburg study of perioperative risk , 1994 .

[7]  D. Heuser,et al.  Qualitätssicherung in der Anästhesie ― zwischen Akzeptanz und Realisierung , 1993 .

[8]  Nancy M. Lorenzi,et al.  Review: Antecedents of the People and Organizational Aspects of Medical Informatics: Review of the Literature , 1997, J. Am. Medical Informatics Assoc..

[9]  Effects of Information Feedback and Pulse Oximetry on the Incidence of Anesthesia Complications , 1987, Anesthesiology.

[10]  W. Tweed,et al.  The Canadian four-centre study of anaesthetic outcomes: II. Can outcomes be used to assess the quality of anaesthesia care? , 1992, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[11]  H. Devlin,et al.  Reporting to NCEPOD. , 1992, BMJ.

[12]  K. Svärdsudd,et al.  Peroperative and immediate postoperative adverse events in patients undergoing elective general and orthopaedic surgery: The Gothenburg study of perioperative risk (PROPER). Part II , 1995, Acta anaesthesiologica Scandinavica.

[13]  J P Abenstein,et al.  Anesthesia Providers, Patient Outcomes, and Costs , 1996, Anesthesia and analgesia.

[14]  L. Eberhart,et al.  Perioperative Anästhesieverlaufsbeobachtungen, postanästhesiologische Visite und Befragung zur Patientenzufriedenheit - Eine prospektive Studie zu Parametern der Prozeß- und Ergebnisqualität in der Anästhesie , 1996 .

[15]  J. Cooper,et al.  An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection. , 1984 .

[16]  L. Tiret,et al.  Complications associated with anaesthesiaa — prospective survey in France , 1986, Canadian Anaesthetists' Society journal.

[17]  K. Sanborn,et al.  Detection of Intraoperative Incidents by Electronic Scanning of Computerized Anesthesia Records: Comparison with Voluntary Reporting , 1996, Anesthesiology.

[18]  Jeffrey B Cooper,et al.  Preventable anesthesia mishaps: a study of human factors. 1978. , 1978, Quality & safety in health care.

[19]  W. J. Russell,et al.  Errors, Incidents and Accidents in Anaesthetic Practice , 1993 .

[20]  T. Pedersen,et al.  A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity , 1990, Acta anaesthesiologica Scandinavica.

[21]  A. Donabedian The quality of care. How can it be assessed? , 1988, JAMA.

[22]  W. Friesdorf,et al.  Ergonomics applied to anaesthesia record keeping , 1993, International journal of clinical monitoring and computing.

[23]  M. Hägerdal,et al.  Reported anaesthetic complications during an 11‐year period. A retrospective study , 1992, Acta anaesthesiologica Scandinavica.

[24]  P. Myles,et al.  Analysis of demographic characteristics. , 1994, Anaesthesia and intensive care.