Quality, safety, and outcomes in anaesthesia: what’s to be done?An international perspective
C J Peden, M Campbell, G Aggarwal
This article reviews some of the key topics and challenges in quality, safety, and the measurement and improvement of outcomes in anaesthesia globally. It highlights current areas of concern and potential solutions in a systematic way, where healthcare system is viewed from three different levels: the microsystem or patient and individual clinician perspective; the meso or hospital perspective; and the macro or government and policy perspective.
The article celebrates the successes of the specialty of anaesthesia in improving the quality, safety, and outcomes for our patients, and looks into future developments, including greater use of technology and patient engagement.
Making the experience of elective surgery better
T Fregene, S Wintle,V Venkat Raman, H Edmond,S Rizvi
Patient experience is one of the three pillars of quality in healthcare; improving it must be a key aim if we are to make the overall quality of the healthcare we provide better. We devised a quality improvement project to improve the patient experience of elective surgery. We conducted surveys of patients and assessed their experience by using semistructured interviews and patient questionnaires. We gathered data about their overall satisfaction, fasting times and their communication with staff. We used this information to inform strategies aimed at improving patient experience.
This project increased the percentage of patients reporting an ‘Excellent’ or ‘Good’ experience from 65% to 96%. In addition to improving our patients' experience, our project has also delivered shorter waiting times, better dissemination of information and fewer patients reporting hunger or thirst.
Cardiac output Optimisation following Liver Transplant (COLT) trial: study protocol for a feasibility randomised controlled trial
Froghi F, Koti R, Gurusamy K, Mallett S, Thorburn D, Selves L, James S, Singh J, Pinto M, Eastgate C, McNeil M, Filipe H, Jichi F, Schofield N, Martin D, Davidson B
Patients with liver cirrhosis undergoing liver transplantation have a hyperdynamic circulation which persists into the early postoperative period making accurate assessment of fluid requirements challenging. Goal-directed fluid therapy (GDFT) has been shown to reduce morbidity and mortality in a number of surgery settings. The impact of GDFT in patients undergoing liver transplantation is unknown. A feasibility trial was designed to determine patient and clinician support for recruitment into a randomised controlled trial of GDFT following liver transplantation, adherence to a GDFT protocol, participant withdrawal, and to determine appropriate endpoints for a subsequent larger trial to evaluate the efficacy of GDFT in patients undergoing liver transplantation.
The association of abdominal muscle with outcomes after scheduled abdominal aortic aneurysm repair
Shah N, Abeysundara L, Dutta P, Christodoulidou M, Wylie S, Richards T, Schofield N
Sarcopenia is the degenerative loss of core muscle mass. It is an aspect of frailty, which is associated with increased rates of peri-operative harm. We assessed the association of the cross-sectional areas of abdominal muscles, including psoas, with survival during a median (IQR [range]) follow-up of 3.8 (3.2-4.4 [0.0-5.1]) years after scheduled endovascular (132) or open (5) abdominal aortic aneurysm repair in 137 patients. In multivariate analysis, mortality hazard (95%CI) was independently associated with: age, 1.06 (1.01-1.13) per year, p = 0.03; and the adjusted area of the left psoas muscle, 0.94 (0.81-1.01) per mm2 .kg-0.83 , p = 0.08. Shortened hospital stay was independently associated with haemoglobin concentration and adjusted left psoas muscle area, hazard ratio (95%) 1.01 (1.00-1.02) per g.l-1 and 1.05 (1.02-1.07) per mm2 .kg-0.83 , p = 0.04 and 0.001, respectively.