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Perioperative structure and process quality and safety indicators: a systematic review.
M Chazapis1, D Gilhooly1, A F Smith2
1Institute of Epidemiology and Applied Health Research, UK; UCLH Surgical Outcomes Research Centre, Department of Applied Health Research, UK; Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, UK; National Institute for Academic Anaesthesia's Health Services Research Centre, Royal College of Anaesthetists, London, UK.
British Journal of Anaesthesia
|February 5, 2018
Summary
Most clinical indicators for perioperative care lack strong scientific evidence. Developing and validating these quality and safety metrics requires standardized approaches to ensure effectiveness and patient safety.
Area of Science:
- Healthcare quality measurement
- Perioperative care standards
- Clinical indicator research
Background:
- Clinical indicators are vital for assessing healthcare quality, encompassing structures, processes, and outcomes.
- The scientific evidence underpinning the vast number of clinical indicators is often unclear.
- This study focuses on perioperative care, evaluating the evidence base of structure and process indicators.
Purpose of the Study:
- To determine the number, type, and evidence level of clinical process and structure indicators.
- To assess their application in perioperative quality and safety measurement.
- To identify gaps in the scientific validation of these indicators.
Main Methods:
- Systematic review of multiple databases (Medline, Embase, CINAHL, Cochrane, Google Scholar, Grey Literature).
- Inclusion of English-language human studies (adults, >18) published January 2005-January 2016.
- Inclusion of professional and governmental publications on indicator development and validation.
Main Results:
- Identified 1282 clinical indicators: 36% structure and 64% process.
- Effectiveness (38%) and patient safety (29%) were the most common quality dimensions.
- Over half (53%) of indicators lacked an ascribed level of evidence; patient-centered metrics were least common.
Conclusions:
- The majority of widely used clinical indicators lack robust scientific evidence.
- There is a need for standardized development and validation processes for clinical indicators.
- Current indicators primarily address effectiveness, safety, and efficiency in care.
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