In Volume 2 of this two-volume International Anesthesiology Clinics set focusing on quality in anesthesia, Richard Dutton, a world renowned expert, expands on the basics of setting up a quality management program and introduces the reader to more advanced topics. We live in a time of increasing need to exhibit safety and value in health care. This is particularly true in anesthesia practices. Hence, having and understanding of the topics discussed in Volume 2 is both timely and important for those in anesthesia quality management.
In Chapter 1, Dr. Dutton gives a brief history of safety in anesthesia, which has often been at the forefront of medical safety movements. He then introduces the reader to the Anesthesia Quality Institute and the National Anesthesia Clinical Outcomes Registry, which Anesthesia Quality Institute maintains. He also discusses the National Anesthesia Clinical Outcomes Registry, Anesthesia Incident Reporting System, Closed Claims Project, and Patient Awareness Registry. By doing so, he gives the reader an understanding of where to look for research databases as well as projects in which to participate for those who wish to contribute to the rapidly growing entity of anesthesia quality management. He finishes the chapter with possible future registries, including a very interesting thought of having a patient-facing incident-reporting system where information will be elicited from patients. This may lead to a new focus of what is important in anesthesia quality measurement and outcomes.
Chapter 2 focuses on high-performing anesthesia practices. Three senior members of the American Society of Anesthesiologists’ Committee write this chapter on Quality Management—Drs. Hattamer, Hicks, and Arnold. This highly informative and useful chapter gives great insight on how to run a quality assurance meeting. It answers the questions pertaining to legal risk and “discovery” associated with having such meetings that many of us have when participating in similar groups. It also provides information about using outside consultants as well as other tools that could be useful as a practice starts to evaluate its own quality. The sections on professionalism, communication, and leadership are concise and should be read by all who practice anesthesia. There are useful chapters on using anesthesia information systems, which is a heavy focus throughout the text. Additionally, there are well-written chapters on how to learn from sentinel events, as well as the principles and importance of incident reporting. In one of the more unique chapters, Drs. Stieglar and Dhillion discuss what a cognitive error is and make excellent use of common anesthesia cases demonstrating how decision-making errors occur. They provide a framework for understanding how we can all recognize decision errors in colleagues and ourselves and what can be done to prevent them. Through the use of timely, specific, and rational feedback, this chapter also provides insight into what a quality review committee could do to prevent errors when they are the reason for an adverse event in their practice. The text concludes with quality management discussion in two specific locations, namely the outpatient setting and in global health. In the chapter on outpatient anesthesia, the reader will find discussions pertaining to measuring quality and how that will be linked to Medicare payments to be of great importance. The last chapter, which discusses anesthesia from a global perspective, is brief but highlights the importance of taking quality advances to low- and middle-income countries and the challenges facing such endeavors.
Overall, this text is a logical and complementary addition to the first. There is very little redundancy between the two texts, which is surprising given their singular focus. After reading this volume, the reader will have greater insight into the work that is going on in anesthesia quality management. Without question, this second volume gives great insight into how to establish a quality management program at one’s institution. Although the chapters in this second volume are more advanced, according to Dr. Dutton this text is as readable as the first. Novice and experienced quality managers alike will find this second volume useful and easy to read and understand. I highly recommend anyone interested in quality in anesthesia, which should be all of us, to read both texts.
