[Quality assurance in North American anesthesia]

To monitor the quality of care and identify opportunities to improve that care, the Department of Anesthesiology at Hutzel Hospital, Detroit (USA) has developed a quality assurance program. While the use of indicators represents the principal means of obtaining relevant quality of care information, there are several additional data sources that provide the departmental quality assurance committee with the necessary body of information to recognize problems in the delivery of anesthesia care and formulate indicated remedial actions. These can take the form of lectures, development of guidelines, or the acquisition of needed equipment. If identified problems are traceable to a specific practitioner, a number of interventional options are available to the chief of the department, ranging from individual counselling to recommending the removal of clinical privileges. The various corrective actions that have been instituted have led to improvements in clinical care, but perhaps of greater importance are the intangible changes in practice patterns that have occurred as a result of everyone's awareness that an effective monitoring process exists.