title: Measuring and improving the quality of postoperative epidural analgesia for major abdominal surgery using statistical process control charts.
abstract: OBJECTIVE
  To explore and improve the quality of continuous epidural analgesia for pain relief using Statistical Process Control tools.
  
  
  BACKGROUND
  Measuring the quality of pain management interventions is complex. Intermittent audits do not accurately capture the results of quality improvement initiatives. The failure rate for one intervention, epidural analgesia, is approximately 30% in everyday practice, so it is an important area for improvement. Continuous measurement and analysis are required to understand the multiple factors involved in providing effective pain relief.
  
  
  METHODS
  Process control and quality improvement
  
  
  METHODS
  Routine prospectively acquired data collection started in 2006. Patients were asked about their pain and side effects of treatment. Statistical Process Control methods were applied for continuous data analysis. A multidisciplinary group worked together to identify reasons for variation in the data and instigated ideas for improvement. The key measure for improvement was a reduction in the percentage of patients with an epidural in severe pain.
  
  
  RESULTS
  The baseline control charts illustrated the recorded variation in the rate of several processes and outcomes for 293 surgical patients. The mean visual analogue pain score (VNRS) was four. There was no special cause variation when data were stratified by surgeons, clinical area or patients who had experienced pain before surgery. Fifty-seven per cent of patients were hypotensive on the first day after surgery. We were able to demonstrate a significant improvement in the failure rate of epidurals as the project continued with quality improvement interventions.
  
  
  CONCLUSIONS
  Statistical Process Control is a useful tool for measuring and improving the quality of pain management.
  
  
  CONCLUSIONS
  The applications of Statistical Process Control methods offer the potential to learn more about the process of change and outcomes in an Acute Pain Service both locally and nationally. We have been able to develop measures for improvement and benchmarking in routine care that has led to the establishment of a national pain registry.
authors.affiliation: Research Institute for Health and Social Change, Elizabeth Gaskell Campus, Manchester Metropolitan University, Manchester.
authors.forename: Fiona
authors.initials: F
authors.lastname: Duncan
authors.forename: Carol
authors.initials: C
authors.lastname: Haigh
mesh_terms: D000005:Abdomen / Q000601:surgery*; D015360:Analgesia, Epidural / Q000592:standards*; D006801:Humans; D011182:Postoperative Care; D011787:Quality of Health Care; D013514:Surgical Procedures, Operative / Q000009:adverse effects*
keywords: management; pain; quality