(OPPE) Using Automatically Captured Electronic Anesthesia Data

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The Joint Commission Journal on Quality and Patient Safety
or a simulated patient scenario modifies behavior. It also has
minimal costs to install and maintain and is unbiased in its measurement
of clinical performance. It is not intended to provide a
complete system for measuring competence but rather to serve
as a first-round warning mechanism and metric scoring tool to
identify problems and potential performance noncompliance issues.
Numerous problems can arise in the process of delivering
anesthesia care (or any clinical practice), such as failure to perform
basic patient monitoring in a fashion that ensures the safety
of the patient. Continuous and transparent systems such as ours
enable physicians to self-assess their performance and make adjustments
to correct issues before engaging in the credentialing
process.
Although the process of credentialing professionals in health
care is not new, 16–18 there are few in-depth analyses of physician
performance evaluation, and most are focused on overtly technical
skills; some address generalized professional skill sets. Generalizable
skills and specialized knowledge are both important to
clinical care and should be included in any competence metric. 19
Surgery and endoscopy practices place a high value on quantifying
technical skills. 20–22 In anesthesia, it has been suggested that
technical clinical performance can also be readily evaluated by
simulation 23 or control chart methodology. 24
The development of our credentialing system reflects similar
work reported by others. 25 Schartel and Metro suggest that evaluation
should take place close to the time of the clinical encounter
and should be intended to not only correct mistakes but
also continuously improve performance. 26 Fried and Feldman
state that technical performance measurements should be objective
and practical for a clinical specialty. 27 Hill argues for standardized
credentialing, 28 but we believe that it is nearly
impossible to standardize the clinical behavior of an entire profession.
Credentialing parameters should be specific enough to
enhance patient care by resolving issues within a specialty. 29 In
any case, because of uneven adoption of technology—for example,
clinical data coding is not universal—it would be unrealistic
to set standards beyond the capacity of smaller hospitals. 30
The purpose of credentialing is to improve patient care, and thus
should be dictated by each specialty’s organization and the health
care institutions themselves.
It should be noted that the purpose of our work was to design
a credentialing process suitable to our own department, with its
particular work flow and clinical practice, rather than for all
medical specialties or even anesthesia as a whole. These metrics
are intended to apply to anesthesiologists in clinical practice in
the OR—who constitute the vast majority of hospital-based
practicing anesthesiologists—and will not apply to all anesthesiologists,
such as pain and ICU physicians. However, we believe
that our results as presented have broad applicability to fields in
which significant structured clinical and compliance documentation
are important components of clinical practice.
Other fields of medicine, particularly ICUs, have used a similar
methodology to enact a system of defining and measuring
metrics of patient care and physician performance. For example,
Wahl et al., without incurring the need for additional personnel,
used a computerized system to collect data on ICU core
mea sures—glucose management, head of bed angle, prophylaxis,
and ventilator weaning. 31
MIDCOURSE CORRECTIONS AND NEXT STEPS
We are in the process of developing additional metrics, coupled
with a determination of which metrics to add or remove on
the basis of their performance over time. Potential future metrics
may include those based on the total case duration or “time-inflight,”
as opposed to what we have initially used, that is; casebased
metrics (items that occur only once per case). This
adjustment reflects the fact that some of our clinicians (for example,
members of our cardiac group) perform a small number
of long cases, as opposed to the majority of clinicians, who administer
a moderate number of relatively short-duration anesthetics.
The long-term goal of the credentialing system is to
develop a comprehensive group of metrics that best represents
the scope of clinical OR anesthesiology.
February 2012 Volume 38 Number 2
Sample Summary Plot
Figure 2. This sample summary plot for the Timely Documentation of Compliance
Statements metric displays the percentage of passing cases. The mean
baseline passing values (horizontal line) are indicated, as are the failure cutoff
point (vertical line), for just over 100 physicians.
Copyright 2012 © The Joint Commission