title: Performance improvement system and postoperative corneal injuries: incidence and risk factors.
abstract: BACKGROUND
  The authors' department conducted a performance improvement initiative aimed to reduce the rate of perioperative corneal injuries. This study reports the effects of the initiative and examines the risk factors for corneal injury.
  
  
  METHODS
  The rate of corneal injuries during nonophthalmologic procedures under anesthesia was compared between the two time periods: preinitiative baseline (August 1, 2005-December 31, 2005) and initiative period (January 1, 2006-April 30, 2007). To examine the risk factors for corneal injury, a nested case-control study with a 2:1 matched-set design was separately performed and included cases between January 1, 2006 and July 31, 2008.
  
  
  RESULTS
  During the baseline period, the corneal injury rate was 1.51 per 1,000, and it decreased to 0.79 per 1,000 during the performance initiative (P = 0.008). Independent risk factors were longer anesthetics (odds ratio = 1.2, 95% confidence interval (CI) 1.1-1.3 per 30 min), lower American Society of Anesthesiologists physical status (odds ratio 0.5, 95% CI 0.3-0.8 for American Society of Anesthesiologists physical status 3-4 vs. 1-2), and student nurse anesthetist as a primary anesthesia provider (odds ratio 2.6, 95% CI 1.3-5.0).
  
  
  CONCLUSIONS
  Corneal injury rate in our institution was significantly reduced and remains at low levels long after initiation of perioperative eye care improvement initiative. The higher rate of corneal injuries among student nurse anesthetists highlights the importance of standardizing education and supervision among all anesthesia providers. We believe that our model of performance improvement initiative can be used to improve other perioperative outcomes.
authors: College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors: David P
authors: DP
authors: Martin
authors: Toby N
authors: TN
authors: Weingarten
authors: Paul W
authors: PW
authors: Gunn
authors: Kunmoo
authors: K
authors: Lee
authors: Michael A
authors: MA
authors: Mahr
authors: Darrell R
authors: DR
authors: Schroeder
authors: Juraj
authors: J
authors: Sprung
mesh_terms: D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000758:Anesthesia; D000768:Anesthesia, General / Q000009:adverse effects*; D016022:Case-Control Studies; D003228:Conjunctiva / Q000473:pathology; D065306:Corneal Injuries; D005131:Eye Injuries / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009719:Nurse Anesthetists; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control*; D012307:Risk Factors