(OPPE) Using Automatically Captured Electronic Anesthesia Data

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The Joint Commission Journal on Quality and Patient Safety
novel strategy to avoid the high resource and time costs associated
with traditional methods of clinical performance evaluation.
Even if we developed a process that required only one hour of
physician time and one hour of administrative time (both conservative
estimates), the need to perform the OPPE process more
frequently than annually would result in sequestration of several
hundreds of hours of physician and administrative time. Removing
clinicians from direct patient care to comply with the OPPE
mandate would be a significant financial burden and drain on
clinical efficiency. To avoid such a significant impact on clinical
operations, we sought to create a process that could use readily
available, automatically captured electronic information from
our vendor-provided anesthesia information management system
(AIMS) to address The Joint Commission’s OPPE requirements.
A fully implemented AIMS has been in place in each of
our 70 anesthetizing locations since 2002. The AIMS data provide
reliable and extensive documentation of clinical monitoring
and physician practice patterns.
Our primary goal in creating the OPPE process was to develop
a system that (1) requires little or no additional effort on
behalf of the clinician being evaluated and (2) minimizes or eliminates
the modified behavior effect that an observer or mock patient
might create. We also attempted to create a system that
would be unbiased in its measurement of clinical behavior, con-
Table 1. Common Methods of Performance Review
Review Method Advantages Disadvantages
Chart Review Large sample size Difficult to interpret
Randomized Charts can be “smoothed” afterward
No observer effect Retrospective bias
Direct Observation High level of detail Time consuming and expensive
Contextual Observer effect
Immediate feedback Observer bias
Difficult to review many cases
Simulated Patients Controlled and repeatable Time consuming and expensive
Observer bias
Observer effect
360-Degree Evaluation Balanced/minimized bias Time consuming and expensive
Video Review Reduces observer effect Time consuming and expensive
Difficult to interpret
Retrospective bias
Control Charting No observer effect Charts can be “smoothed” afterward
Continuous Retrospective bias
Easy to measure
tinuous, and relatively inexpensive to install and maintain. Such
a system, which could provide feedback that was both continuous
and transparent, would enable physicians to self-assess their
own performance and make adjustments to correct issues before
the actual credentialing process.
Methods
THE COMMITTEE’S CHARGE: DESIGN A SET OF
CREDENTIALING METRICS
We began by establishing the OPPE credentialing committee in
fall 2008 to design a set of meaningful credentialing metrics.
This committee consisted of six senior staff physicians [including
J.M.E., R.A.P., W.S.S. (chair)] representing a broad crosssection
of the department’s clinical activities—including
pediatric, transplant, neurosurgical, orthopedic, and vascular
anesthesia. The committee conducted a literature search and
consulted with other hospitals and departments to generate and
examine a list of existing methods of physician performance evaluation.
The committee discussed the advantages and disadvantages
of the commonly used methods to review physician
competency in its efforts to design a solution that was modeled
on the strengths of successful methods. A partial list of commonly
used methods to evaluate clinical performance is provided
in Table 1 (above).
A major goal of the committee was to ensure that metrics
February 2012 Volume 38 Number 2
Copyright 2012 © The Joint Commission