On the scientific front, NACOR makes data available to support comparative effectiveness and health policy research by physician scientists in any AQI-participating practice. AQI released the first Participant User File (PUF) in early 2013 and updates it every quarter. The PUF is an aggregated, de-identified version of NACOR that includes hundreds of data fields describing patients, procedures, anesthetics and outcomes from the millions of cases in NACOR. The PUF has been shared with investigators at more than a dozen academic practices around the country, and numerous descriptive and analytic studies are currently underway. In time, NACOR will provide us with a new and comprehensive understanding of the nature of anesthesiology in the U.S. The AQI uses the PUF internally to provide dashboards of summary data for ASA and state society leaders, ASA committees, and anesthesia subspecialty societies. Information and instructions for accessing AQI data can be found on the AQI website.
Mentioned previously, the Anesthesia Incident Reporting System (AIRS) was launched in 2011 and has grown steadily since. The AIRS registry currently includes narrative descriptions of more than 900 serious adverse events, unsafe conditions, and near misses using formats that allow the AQI to share de-identified case descriptions with other patient safety organizations and national anesthesia societies. This capability will greatly improve the speed with which serious complications of anesthesia and emerging patient safety risks are recognized, even for very rare events. The AIRS Steering Committee has published 32 written case vignettes in the ASA Newsletter highlighting opportunities for improving care. The AQI has just released a mobile app for reporting events from smart phones and tablets, available on the App Store or Google Play by searching “AQI AIRS” or by linking to either site from the main AQI website.
The main AQI site also includes educational material to inform quality management efforts for groups and individuals. These include guidelines for how to establish a departmental QM program, suggestions on where and how to collect data in various practice settings, links to vendors of healthcare information technology that can help practices collect quality data and transmit it to the AQI, and sample quality capture forms for different purposes and settings. The intention is to make the AQI website a useful resource for both practices and vendors. The AQI also assists the ASA Education Division by managing the Practice Performance Assessment and Improvement (PPAI) database. This activity, promoted by the ASA to help anesthesiologists meet the Part IV requirements for Maintenance of Certification, involves collection of clinical information before and after completing an educational activity. The purpose is to teach the basics of the “plan-do-study-act” cycle of quality management.
Since 2012, the AQI has managed the Closed Claims Project for the ASA. The Anesthesia Closed Claims Project and its registries are collaborative, multidisciplinary projects that work to identify safety concerns in anesthesia, patterns of injury, and develop strategies for prevention in order to improve patient safety. The registries consist of the Anesthesia Closed Claims Project, the Postoperative Visual Loss Registry, the Anesthesia Awareness Registry, and the Neurologic Injury after Non-Supine Shoulder Surgery (NINS) Registry. The goals of these initiatives are to learn from the most serious events that affect providers and patients in a detailed and systematic fashion. Dozens of anesthesiologists volunteer their time each year to perform case reviews of closed malpractice cases, through access provided by the insurers themselves. The reports they submit are maintained in a registry, the contents of which reach back to the late 1970s, and now includes more than 10,000 case descriptions.
The AQI is also participating in new ASA quality initiatives. One is the inaugural Anesthesia Quality Meeting that took place in November 2013 in the greater Chicago area. This weekend course was intended to teach the basics of quality management in an anesthesia practice to anesthesia department quality officers. AQM-1 sold out quickly and received excellent reviews. The AQI and ASA will be offering a second AQM meeting in April 2014 in Dallas. More information can be found on the ASA website. A second initiative, in partnership with the ASA’s Quality Management and Departmental Administration (QMDA) Committee, is a “Quality Consultation” program to provide high-functioning anesthesia practices with national benchmarking of their efforts, documentation of clinical performance, and suggestions for further improvement. The consultation is based on a review of practice structure, NACOR data, personal interviews, and a one-day site visit by a team of experienced, practicing anesthesiologists. For more information on quality consultations, contact Dr. Richard Dutton, M.D., M.B.A..