Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists
Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists
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DOI：
10.1097/00000539-199905000-00023
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发表时间：
1999-05-01
影响因子：
5.7
通讯作者：
Lee, M
中科院分区：
文献类型：
--
作者：
Macario, A;Weinger, M;Lee, M
麻醉小组可能需要确定要跟踪哪些临床麻醉结果，作为质量改进工作的一部分。本研究的目的是对麻醉专家小组进行民意调查，以确定哪些与常规门诊手术相关的临床麻醉结果被认为经常发生并且需要避免。然后，可以优先考虑在两个量表中得分较高的结果，以在门诊临床实践中进行测量和改进。一份邮寄的调查工具指示小组成员以两个等级对 33 种临床麻醉结果进行评分：他们认为这些结果发生的频率以及他们期望患者认为重要的是要避免哪些结果。反馈过程（德尔菲过程）用于获得每个量表结果的共识排名。然后对重要性和频率分数进行同等加权，以对结果进行定性排序。在 72 名麻醉师中，56 名 (78%) 完成了调查问卷。综合得分最高的五个项目是（按顺序）：切口疼痛、恶心、呕吐、术前焦虑和电视插入不适。为了提高护理质量，应优先考虑降低这些结果的发生率和严重程度。意义：麻醉专家就哪些低发病率临床结果常见且对患者重要达成了共识。确定的结果可能是作为动态麻醉临床质量改进工作的一部分进行监测的合理选择。
Anesthesia groups may need to determine which clinical anesthesia outcomes to track as part of quality improvement efforts. The goal of this study was to poll a panel of expert anesthesiologists to determine which clinical anesthesia outcomes associated with routine outpatient surgery were judged to occur frequently and to be important to avoid. Outcomes scoring highly in both scales could then be prioritized for measurement and improvement in ambulatory clinical practice. A mailed survey instrument instructed panel members to rate 33 clinical anesthesia outcomes in two scales: how frequently they believe the outcomes occur and which outcomes they expect patients find important to avoid. A feedback process (Delphi process) was used to gain consensus rankings of the outcomes for each scale. Importance and frequency scores were then weighted equally to qualitatively rank order the outcomes. Of the 72 anesthesiologists, 56 (78%) completed the questionnaire. The five items with the highest combined score were (in order): incisional pain, nausea, vomiting, preoperative anxiety, and discomfort from TV insertion. To increase quality of care, reducing the incidence and severity of these outcomes should be prioritized. Implications: Expert anesthesiologists reached a consensus on which low-morbidity clinical outcomes are common and important to the patient. The outcomes identified may be reasonable choices to be monitored as part of ambulatory anesthesia clinical quality improvement efforts.