[Analgesic quality in a postoperative pain service: continuous assessment with the cumulative sum (cusum) method].
OBJECTIVE
The aim of this study was to assess the cumulative sum (cusum) method for evaluating the performance of our hospital's acute postoperative pain service.


METHODS
The period of analysis was 7 months. Analgesic failure was defined as a score of 3 points or more on a simple numerical scale. Acceptable failure (p0) was set at 20% of patients upon admission to the postanesthetic recovery unit and at 7% 24 hours after surgery. Unacceptable failure was set at double the p0 rate at each time (40% and 14%, respectively). The unit's patient records were used to generate a cusum graph for each evaluation.


RESULTS
Nine hundred four records were included. The rate of failure was 31.6% upon admission to the unit and 12.1% at the 24-hour postoperative assessment. The curve rose rapidly to the value set for p0 at both evaluation times (n = 14 and n = 17, respectively), later leveled off, and began to fall after 721 and 521 cases, respectively.


CONCLUSIONS
Our study shows the efficacy of the cusum method for monitoring a proposed quality standard. The graph also showed periods of suboptimal performance that would not have been evident from analyzing the data en block. Thus the cusum method would facilitate rapid detection of periods in which quality declines.
Baptista Macaroff
W M
WM
Unidad de Dolor Agudo Postoperatorio. Departamento y Cátedra de Anestesiología, Hospital de Clínicas "Dr. Manuel Quintela", Montevideo, Uruguay. baptistaw@gmail.com
Castroman Espasandín
P
P
D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods / Q000706:statistics & numerical data*; D015360:Analgesia, Epidural / Q000706:statistics & numerical data; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000706:statistics & numerical data*; D010149:Postoperative Pain / Q000188:drug therapy*; D011184:Postoperative Period; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D011786:Quality Control; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
D000700:Analgesics