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Mini-audits facilitate quality assurance in outpatient units

[Des mini-audits contribuent à l'assurance qualité en consultation externe]

From the Department of Anaesthesia, Vancouver General Hospital, Vancouver, British Columbia, Canada.

Address correspondence to: Dr. Himat Vaghadia, Department of Anaesthesia (JPP 2449) Vancouver General Hospital, 855 West 12^th Avenue, Vancouver, British Columbia V5Z 4E3, Canada. Phone: 604-875-4575; Fax: 604- 875-5209; E-mail: hvaghadi{at}vanhosp.bc.ca

Purpose: It has been shown that large-scale epidemiological studies are an unsatisfactory method of measuring quality of care in anesthesia. We performed a mini-audit of the outpatient surgery unit at Vancouver General Hospital to determine whether such methodology would be helpful in assessing and monitoring quality of care and in identifying areas where improvements could be made.

Methods: After institutional approval, we conducted a prospective quality assurance audit in a cohort of 462 consecutive outpatients. A measurement tool was developed using information from previous literature. Data recorded included demographics, type of surgery and anesthesia, duration of stay in the postanesthetic care unit (PACU) and any adverse events in the PACU. The effect of ethnicity on the above was also examined.

Results: The demographics and practice profiles of our unit were comparable to other units. The mean duration of stay in the PACU was 91 ± 55.3 min and is twice as long as other units. The incidence of hypotension, hypothermia and excessive pain in the PACU were higher compared to other centres. The incidence of other adverse events was comparable to that reported by other centres. O₂ supplementation was required more frequently in Caucasians (23% vs 9%; P <0.05) and postoperative bleeding occurred more frequently in Asiatics (46% vs 27%; P <0.05).

Conclusion: A mini-audit was found to be helpful in assessing and monitoring quality of care and in identifying areas where improvements could be made.