Using an international clinical registry of regional anesthesia to identify targets for quality improvement.
Using an international clinical registry of regional anesthesia to identify targets for quality improvement.
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DOI：
10.1097/aap.0000000000000162
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发表时间：
2014-11
影响因子：
5.1
通讯作者：
Davis M
中科院分区：
文献类型：
--
作者：
Sites BD;Barrington MJ;Davis M
尽管区域麻醉被广泛使用，但有关临床表现的信息有限。因此，机构对它们在安全性和有效性方面的表现知之甚少。在这项研究中，我们演示了医疗机构(或医生/医生小组)如何使用来自多中心区域麻醉临床登记的数据来为质量改进策略提供信息。我们分析了来自国际区域麻醉注册中心的数据，其中包括来自世界各地19个中心的外周区域麻醉程序的前瞻性数据。使用临床登记的数据，我们提出了区域麻醉的总体安全性和有效性的汇总统计数据。此外，我们使用各种绩效衡量标准演示了医院如何使用这些数据来确定质量改进的领域。为此，我们将一个成员机构(新罕布夏州的一家美国医疗中心)的表现与临床注册的其他18个成员机构的表现进行了比较。临床登记包含了2011年6月1日至2014年5月1日期间对16,725名患者进行的23,271个区块的信息。总成功率为96.7%，近期并发症发生率为2.2%，神经后遗症全因60d发生率为8.3(95%CI，7.2~9.7)/万。登记范围内的主要医院事件包括7个错误的部位传导阻滞，3个癫痫发作，1个完全性心脏传导阻滞，1个腹膜后血肿和3个气胸。对于我们的参考医疗中心，我们确定了值得提高质量的领域。具体地说，在考虑了患者人口的年龄、性别和健康状况的差异后，参考医疗中心似乎更严重地依赖阿片类药物进行手术后管理，与其他成员机构相比，患者疼痛评分更高，出院延迟。据我们所知，这是第一次使用临床登记来提供代表区域麻醉安全性和有效性的比较结果比率的大规模努力。这些结果可以用来帮助制定质量改进策略。
Despite the widespread use of regional anesthesia, limited information on clinical performance exists. Institutions, therefore, have little knowledge of how they are performing in regards to both safety and effectiveness. In this study, we demonstrate how a medical institution (or physician/physician group) may use data from a multi-center clinical registry of regional anesthesia to inform quality improvement strategies. We analyzed data from the International Registry of Regional Anesthesia that includes prospective data on peripheral regional anesthesia procedures from 19 centers located around the world. Using data from the clinical registry, we present summary statistics of the overall safety and effectiveness of regional anesthesia. Furthermore, we demonstrate, using a variety of performance measures, how these data can be used by hospitals to identify areas for quality improvement. To do so, we compare the performance of one member institution (a United States medical center in New Hampshire) to that of the other 18 member institutions of the clinical registry. The clinical registry contained information on 23,271 blocks that were performed between June 1, 2011, and May 1, 2014, on 16,725 patients. The overall success rate was 96.7%, immediate complication rate was 2.2%, and the all-cause 60-day rate of neurological sequelae was 8.3 (95% CI, 7.2–9.7) per 10,000. Registry wide major hospital events included 7 wrong site blocks, 3 seizures, 1 complete heart block, 1 retroperitoneal hematoma, and 3 pneumothoraces. For our reference medical center, we identified areas meriting quality improvement. Specifically, after accounting for differences in the age, sex, and health status of patient populations, the reference medical center appeared to rely more heavily on opioids for post procedure management, had higher patient pain scores, and experienced delayed discharge when compared with other member institutions. To our knowledge, this is the first large-scale effort to use a clinical registry to provide comparative outcome rates representing the safety and effectiveness of regional anesthesia. These results can be used to help inform quality improvement strategies.