This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Vandebeek, C. A. Articles by Ansermino, J. M. Search for Related Content PubMed Articles by Vandebeek, C. A. Articles by Ansermino, J. M.

CLINICIAN-RELEVANT QUALITY MEASUREMENT FOR PEDIATRIC DAY SURGERY PROGRAMS

Department of Anesthesia, British Columbia’s Children’s Hospital, 4480 Oak Street, Room 1L7, Vancouver, BC V6H 3V4

INTRODUCTION

The optimal allocation of squeezed health care budgets cannot be accomplished without ongoing measurement of the quality of health care provision. More patients than ever are serviced in day case surgery. Other institutions have broadened the scope of their quality management practices to include client-assessed outcomes (1); however, a formal validated and reliable questionnaire for measuring the quality of pediatric day surgery programs has not been developed (2).

This is the item generation phase for a larger project of developing a valid and reliable quality measurement tool. This exploratory study aims to uncover the main quality indicators from the perspective of clinicians; hence, a qualitative approach was considered appropriate.

METHODS

Written informed consent was obtained from four anesthesiologists, four surgeons and six nurses. Each semi-structured in-person interview lasted approximately 45 minutes and was audio taped for full transcription. The transcripts, together with the interviewees’ rankings of the top ten quality indicators, formed the raw data. The data was analyzed for themes using ATLAS/ti qualitative data analysis software. All stages of coding and interpretation were performed independently by an experienced qualitative researcher. This analysis was externally validated by a clinician to compare the perspective of the researcher with that of the subjects.

RESULTS

Thirteen interviews were included. The need for after-discharge data on PONV and pain were themes in the majority of interviews and among the top ten quality indicators for 69% and 77% respectively. The need for measuring the extent to which parents’ were informed about the process flow on the day of surgery was prioritized by 60%.

DISCUSSION

Objective measures of the patient’s recovery that remain paramount to clinicians are currently discontinued at discharge. Clinicians’ sense of duty extends beyond a successful surgery and comfortable recovery period for the patient to their supportive role to parents. As with objective post-discharge measures, clinicians are operating in the dark about the progress of their clinical practice. Satisfaction-related measures showed less potential in helping clinicians improve their practice. While the need for a quality measurement tool is clear, the inclusion of clinician-relevant metrics is requisite to its adoption and sustained use.

REFERENCES

1 National Steering Committee on Patient Safety. 2002. Building a Safer System: a National Integrated Strategy for Improving Patient Safety in Canadian Health Care.

2 Letts M, Davidson D, Splinter W, Conway P. Analysis of the efficacy of pediatric day surgery. Canadian Journal of Surgery. 2001; 44(3):193–198.[Medline]

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Vandebeek, C. A. Articles by Ansermino, J. M. Search for Related Content PubMed Articles by Vandebeek, C. A. Articles by Ansermino, J. M.