Vanderbilt’s anesthesia QI program reduces adverse postoperative events

Understanding human and information systems is central to the efforts of J2 and the ever-important connection between reviewable processes and outcomes measurement. One example of where this matters is Vanderbilt University Medical Center.

Preoperative clinical assessments to detect patients at high risk of postoperative events are important to try and minimize adverse postoperative events. But the threat remains high and hospitals are constantly striving to improve their processes and avoid these costly events.

Vanderbilt University Medical Center is one hospital that has taken on this challenge successfully. With the use of an electronic notification in their anesthesia information system, a window pops up if a glucose level hasn’t been obtained within the past hour. Previously, providers weren’t monitoring blood glucose in patients with diabetes as frequently as their own goals specified. Since adding this notification within their electronic system, “the incidence of hypo—and hyperglycemia in the PACU has diminished, and there’s been a decrease in wound infection rates in diabetic patients,” says Warren Sandberg, MD, PhD, chair of the department of anesthesiology.

Vanderbilt has also added another component to their anesthesiology quality improvement program – peer reviews. This process is designed to detect the outliers practicing differently, but with a different twist. It’s not about tracking so much at an individual level with general indicators or metrics, but rather focusing on where the system can improve to help providers overall. “Nobody practices in isolation. Anesthesiologists, nurse anesthetists, residents, and nurses all work in a system, which makes it hard to attribute a change in performance to an individual,” Dr. Sandberg says. “You need to focus on the team, not individuals.” Peer reviews provide a better understanding of performance than general metrics do by allowing individuals to view the entire process and provide input.

To find out more about what Vanderbilt University Medical Center is doing to enhance their anesthesia quality improvement program, click here.