TY  - CHAP
M1  - Book, Section
TI  - Chapter 26. Approaches to Quality Improvement in Anesthesia Care
A1  - Blike, George T.
A1  - Fleisher, Lee A.
A2  - Longnecker, David E.
A2  - Brown, David L.
A2  - Newman, Mark F.
A2  - Zapol, Warren M.
Y1  - 2012
N1  - 
T2  - Anesthesiology, 2e
AB  - In  the  United  States  there  is  significant  public  dissatisfaction  with  the  level  of  safety  associated  with  medical  care.  This  issue  has  been  taken  up  by  many  legislative  and  governmental  regulatory  bodies  at  both  the  federal  and  state  level.The  demand  for  greater  patient  safety  (ie,  error  reduction)  has  created  multiple  new  levels  of  regulation  and  demands  for  accountability  that  go  well  beyond  the  traditional.The  traditional  approach  of  practitioner  accountability  is  giving  way  to  approaches  that  additionally  emphasize  systems  redesign  and  group-managed  processes.The  demands  for  accountability  require  that  individual  practitioners,  groups  of  practitioners,  hospitals,  and  entire  health  systems  implement  methods  that  allow  documentation  of  outcome  and  process.The  reliance  of  review  systems  such  as  case  conference  and  focus  on  the  individual  patient  is  not  adequate  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  outcome.For  many  practitioners,  reimbursement  will  be  linked  to  both  outcome  and  the  demonstrated  compliance  with  process  variables  such  as  perioperative  antibiotic  administration.  Systems  that  allow  documentation  at  the  individual  patient  level  need  to  be  developed  or  reimbursement  and  accreditation  may  be  compromised.The  level  of  sophistication  with  respect  to  outcome  and  process  evaluation  in  the  intensive  care  unit  has  undergone  much  greater  development  than  that  for  the  operating  room.  A  significant  body  of  work  exists  to  guide  the  improvement  of  care  and  to  decrease  the  error  rate  in  this  area  of  anesthesia  practice.Safety  and  evaluation  of  outcome  for  acute  pain  therapy  lags.  Part  of  this  may  be  related  to  the  fact  that  decisions  about  acute  pain  therapy  are  often  split  between  multiple  groups.  In  addition,  there  is  little  definition  of  what  adequate  levels  of  acute  pain  relief  are,  how  to  accurately  measure  adequacy  of  pain  relief,  or  how  to  monitor  to  prevent  the  complications  of  opioid-based  pain  therapy.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=56628913
ER  -