Quality assurance in anaesthetic practice: comparison between two methods in detecting complications

Area of Science:

• Anesthesiology
• Quality Improvement
• Patient Safety

Background:

• Effective quality systems (QS) in anesthesia require accurate complication identification and documentation.
• Kuopio University Hospital's QS adheres to the ISO 9002 standard.
• External assessment validated routine QS recordings.

Purpose of the Study:

• To evaluate the agreement between external retrospective assessment and routine reporting of anesthetic complications.
• To determine the reliability of complication documentation within a quality system.

Main Methods:

• 1006 anesthetic charts were randomly selected and screened by an external assessor.
• Complications were categorized as minor, severe, or specific to regional anesthesia.
• Cohen's kappa statistics assessed agreement between external assessment and the data management system (DMS).

Main Results:

• Both methods identified complications in 11.4% of cases, but not always the same ones.
• Fair agreement was found for overall (0.72), minor (0.67), severe (0.66), and regional anesthesia complications (0.78).
• Discrepancies occurred in 58 cases, with 13 severe complications missed by retrospective review.

Conclusions:

• A fairly good agreement exists between external assessment and routine reporting of anesthetic complications.
• Significant differences persist, indicating a need to reassess complication selection and definitions.
• Refining criteria is crucial for enhancing the accuracy of quality assurance in anesthesia.