Constructive criticism. Even typing the words made me a little anxious. Did you get a little anxious when you read them? As professionals, we know we’re supposed to welcome critical assessments of our work. However, few of us do, and even fewer like it.
But as medical professionals who literally hold the lives of surgical patients in our hands, it’s imperative for us to understand how what we’re doing affects the quality and safety of patient care and the cost of that care. With all due respect to the internal peer review process and the external reporting of quality metrics to the government, one of the best persons to judge how you’re delivering anesthesia services to your patients is you. Anesthesiologists and certified registered nurse anesthetists must embrace outcomes data and use that data to measure and improve how we practice.
At NorthStar Anesthesia, we encourage all our anesthesiologists and CRNAs to engage in critical self-analysis of their work to ensure that they’re providing the optimum level of care to their patients. That’s who we want working for us, that’s who we want practicing at your hospital or ambulatory surgery center and that’s who patients want practicing at the sites where they’re getting surgery.
An example of the critical self-analysis I’m talking about is a small research project we did at Hillsdale Hospital in Hillsdale, Mich., a 47-bed rural facility located about 112 miles southwest of Detroit. NorthStar’s CRNAs provide anesthesia services at the hospital.
One of the most common procedures at the hospital is shoulder surgery, with three diagnoses being the cause of nearly 70 percent of the caseload: rotator cuff tear, impingement syndrome and ankyloses, or stiffening of the shoulder joint. In most cases and reflecting the current accepted best practice across the country, surgeons at the hospital perform shoulder surgery on an outpatient basis using ultrasound-guided regional anesthesia as opposed to inpatient procedures using general anesthesia.
Our CRNAs wanted to know how their administering of ultrasound-guided regional anesthesia was affecting patients as measured by complications and outcomes. So we pulled the medical records of 76 patients who had shoulder surgery at the hospital in 2014 and dove into the numbers. We looked at pain scores in the post-anesthesia care unit and at discharge. And we looked at postoperative nausea and vomiting rates. We found that the patients’ pain scores were lower than the national averages in both the PACU and at discharge. And we found that the patients’ nausea and vomiting rates were lower than the national averages for patients undergoing the same procedures.
We thought our numbers would be better and that our anesthesia care model at Hillsdale was producing the right clinical and financial outcomes. But we didn’t know for sure until we looked at the data. The study findings verified our assumptions.
Just as important, though, is the fact that we were willing to take the risk that the numbers would not be better and that our anesthesia care model at Hillsdale was not producing the desired results. If that were the case, we were willing to make changes in our practice protocols to achieve better outcomes.
Continuous performance improvement should be the mindset of every anesthesiologist and CRNA, and one of the best tools to do that is quality, safety and cost outcomes data. You should be looking at your numbers all the time.
