The Canadian four-centre study of anaesthetic outcomes: II. Can outcomes be used to assess the quality of anaesthesia care?

摘要: Since anaesthesia, unlike medical or surgical specialties, does not constitute treatment, this study sought to determine if methods used assess outcomes (that is the determination of adverse outcome) are applicable anaesthesia. Anaesthetists collected information on patient, and anaesthetic factors while data recovery room postoperative events were evaluated by research nurses. Data 27,184 inpatients analysis determined for intraoperative, post-anaesthetic care unit time periods. Logistic regression was control differences in patient populations across four hospitals. In addition, a random selection 115 major classified panel anaesthetists into patient-disease contributions. Across three periods, large variations minor found hospitals; these ranged from two-to five-fold after case-mix adjustment (age, physical status, sex, emergency versus elective length anaesthesia). The rates deaths similar one hospital had lower mortality rate (P < 0.001) but higher all 0.0001). Of assessed physician panels, 18.3% some involvement no attributable partially wholly Possible reasons account outcome include compliance recording events, inadequate adjustment, interpretation variables (despite guidelines) institutional monitoring, charting observation protocols. authors conclude that measuring quality anaesthesia comparing unsatisfactory since contribution perioperative uncertain may be explained which beyond anaesthetist. It suggested particularly those concern should next focus improvement