Continuous quality monitoring, feedback and improvement in anaesthetic services

Project film

The research team have produced a 10 minute film outlining the project aims, approach and benefit to patients.  The film features Jill Lloyd (CPSSQ Patient Representative) and interviews with anaesthetists and researchers.  It was produced with support from NIHR CLAHRC, CPSSQ and Imperial College Healthcare NHS.

Project summary

Background

The NHS Next Stage Review called for continuous improvement in the quality of care for patients and reduction of variations in care. Continuous monitoring and reporting of quality of care indicators for clinical effectiveness, clinical safety and patient experience has been identified as an important strategy to drive local service improvement. Despite policy and national initiatives to promote quality improvement approaches in health care, research suggests that current measurement systems and clinical audit processes do not always stimulate improvements in the quality and safety of care. On the individual professional level, the topic of revalidation is receiving growing attention in both anaesthetics and other service areas, particularly on the question of how multisource and patient feedback can be used effectively to improve standards.

Aim

With the support of funding from NIHR CLAHRC North West London and Imperial College Healthcare NHS Trust, we aim to develop, embed and evaluate a continuous quality monitoring, feedback and improvement process within anaesthetic services. The aim of the initiative is to use data on quality of care indicators and service efficiency metrics to provide feedback to clinicians and the clinical department in order to drive continuous monitoring of variation and improvement at both the individual professional and care process levels.

Research rationale

Within anaesthetic services, a recent systematic review of quality indicators identified few commonly agreed and validated indicators to monitor quality of anaesthetic care. Research evidence suggests that feeding back data on processes and outcomes can achieve positive changes in clinical work systems, health care provider behaviour and support professional development. Qualitative studies and reviews have suggested that the requirements for effective data feedback to support improvement are that it should be sustained, transparent, timely, locally relevant, originate from credible sources, be used non-punitively and support remedial action. Little evaluative evidence exists, however, for the efficacy of specific models for monitoring and feedback of data on the quality of care at the clinical microsystems or individual professional levels.

Methods

The study will integrate data collected routinely on perioperative workflow, compliance with best perioperative practice and patient-reported quality of recovery scores, amongst other metrics, in regular feedback to anaesthetists and the anaesthetics department, with supportive elements. Statistical Process Control will be used to analyse data and detect variation. The initiative will be evaluated using a mixed methods quasi-experimental design based upon statistical analysis of time series data, evaluative surveys and interviews.