title: Evaluation of a mandatory quality assurance data capture in anesthesia: a secure electronic system to capture quality assurance information linked to an automated anesthesia record.
abstract: BACKGROUND
  Efforts to assure high-quality, safe, clinical care depend upon capturing information about near-miss and adverse outcome events. Inconsistent or unreliable information capture, especially for infrequent events, compromises attempts to analyze events in quantitative terms, understand their implications, and assess corrective efforts. To enhance reporting, we developed a secure, electronic, mandatory system for reporting quality assurance data linked to our electronic anesthesia record.
  
  
  METHODS
  We used the capabilities of our anesthesia information management system (AIMS) in conjunction with internally developed, secure, intranet-based, Web application software. The application is implemented with a backend allowing robust data storage, retrieval, data analysis, and reporting capabilities. We customized a feature within the AIMS software to create a hard stop in the documentation workflow before the end of anesthesia care time stamp for every case. The software forces the anesthesia provider to access the separate quality assurance data collection program, which provides a checklist for targeted clinical events and a free text option. After completing the event collection program, the software automatically returns the clinician to the AIMS to finalize the anesthesia record.
  
  
  RESULTS
  The number of events captured by the departmental quality assurance office increased by 92% (95% confidence interval [CI] 60.4%-130%) after system implementation. The major contributor to this increase was the new electronic system. This increase has been sustained over the initial 12 full months after implementation. Under our reporting criteria, the overall rate of clinical events reported by any method was 471 events out of 55,382 cases or 0.85% (95% CI 0.78% to 0.93%). The new system collected 67% of these events (95% confidence interval 63%-71%).
  
  
  CONCLUSIONS
  We demonstrate the implementation in an academic anesthesia department of a secure clinical event reporting system linked to an AIMS. The system enforces entry of quality assurance information (either no clinical event or notification of a clinical event). System implementation resulted in capturing nearly twice the number of events at a relatively steady case load.
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Jackson 439, 55 Fruit Street, Boston, MA 02114, USA. RPeterfreund@Partners.org
authors.forename: Robert A
authors.initials: RA
authors.lastname: Peterfreund
authors.forename: William D
authors.initials: WD
authors.lastname: Driscoll
authors.forename: John L
authors.initials: JL
authors.lastname: Walsh
authors.forename: Aparna
authors.initials: A
authors.lastname: Subramanian
authors.forename: Shaji
authors.initials: S
authors.lastname: Anupama
authors.forename: Melissa
authors.initials: M
authors.lastname: Weaver
authors.forename: Theresa
authors.initials: T
authors.lastname: Morris
authors.forename: Sarah
authors.initials: S
authors.lastname: Arnholz
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.forename: Eric T
authors.initials: ET
authors.lastname: Pierce
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Spring
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D000758:Anesthesia / Q000009:adverse effects*; D000761:Anesthesia Department, Hospital / Q000706:statistics & numerical data*; D000776:Anesthesiology / Q000706:statistics & numerical data*; D001900:Boston; D057189:Checklist; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D009870:Operating Room Information Systems / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D061214:Patient Safety / Q000706:statistics & numerical data; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D012984:Software; D057188:Workflow