Comparative performance reports in anaesthesia: impact on clinical outcomes and acceptability to clinicians
WHERE THIS HAPPENED: Harrogate and District NHS Foundation Trust, Bradford Teaching Hospitals NHS Foundation Trust, Royal Free Hospital, London
In anaesthesia, the use of comparative performance reports, their impact on patient care and their acceptability is yet to be fully clarified. Since April 2010, postoperative data on theatre cases in our trust have been analysed and individual comparative performance reports distributed to anaesthetists. Our primary aim was to investigate whether this process was associated with improvement in overall patient care.
A short survey was used to assess our secondary aim, the usefulness and acceptability of the process. There were significant improvements in the odds of all outcomes other than vomiting: 39% improvement in hypothermia (p<0.001); 9.9% improvement in severe pain (p<0.001%); 9.6% improvement in moderate pain (p<0.001); 5.3% improvement in percentage pain free (p=0.04); 9.7% improvement in nausea (p=0.02); 30% improvement in unexpected admissions (p=0.001). 100% of consultant respondents agreed that performance reports prompted reflective practice and that this process had the potential to improve patient care.
The provision of comparative performance reports was thus associated with an improvement in outcomes while remaining acceptable to the anaesthetists involved.
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Improving local anaesthetic systemic toxicity (LAST) awareness in maternity care using tailored educational tools
WHERE THIS HAPPENED: King's College London, Kent & Canterbury Hospital
Queen Elizabeth The Queen Mother hospital (QEQM), a DGH in Margate, is one of two hospitals within East Kent Hospitals University NHS Foundation Trust (EKHUFT) to provide full maternity care: both midwifery and obstetrician-led services. It serves a large geographical area and diverse population in east Kent, and has approximately 2800 births every year.
We observed inconsistent communication of LA risks in this unit, which we suspected were due to poor knowledge as had been reported elsewhere.2–4 Conversation with maternity staff suggested that many were unfamiliar with LAST and there was confusion with anaphylaxis. As baseline data collection confirmed poor LAST awareness across disciplines, and as an interprofessional approach to Quality Improvement (QI) has been associated with maximal safety benefit,5 we were confident that we could expect to improve clinical awareness during this QI project.
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