title: Using an international clinical registry of regional anesthesia to identify targets for quality improvement.
abstract: BACKGROUND
  Despite the widespread use of regional anesthesia, limited information on clinical performance exists. Institutions, therefore, have little knowledge of how they are performing in regard to both safety and effectiveness. In this study, we demonstrate how a medical institution (or physician/physician group) may use data from a multicenter clinical registry of regional anesthesia to inform quality improvement strategies.
  
  
  METHODS
  We analyzed data from the International Registry of Regional Anesthesia that includes prospective data on peripheral regional anesthesia procedures from 19 centers located around the world. Using data from the clinical registry, we present summary statistics of the overall safety and effectiveness of regional anesthesia. Furthermore, we demonstrate, using a variety of performance measures, how these data can be used by hospitals to identify areas for quality improvement. To do so, we compare the performance of 1 member institution (a US medical center in New Hampshire) to that of the other 18 member institutions of the clinical registry.
  
  
  RESULTS
  The clinical registry contained information on 23,271 blocks that were performed between June 1, 2011, and May 1, 2014, on 16,725 patients. The overall success rate was 96.7%, immediate complication rate was 2.2%, and the all-cause 60-day rate of neurological sequelae was 8.3 (95% confidence interval, 7.2- 9.7) per 10,000. Registry-wide major hospital events included 7 wrong-site blocks, 3 seizures, 1 complete heart block, 1 retroperitoneal hematoma, and 3 pneumothoraces. For our reference medical center, we identified areas meriting quality improvement. Specifically, after accounting for differences in the age, sex, and health status of patient populations, the reference medical center appeared to rely more heavily on opioids for postprocedure management, had higher patient pain scores, and experienced delayed discharge when compared with other member institutions.
  
  
  CONCLUSIONS
  To our knowledge, this is the first large-scale effort to use a clinical registry to provide comparative outcome rates representing the safety and effectiveness of regional anesthesia. These results can be used to help inform quality improvement strategies.
authors.affiliation: From the *Department of Anesthesiology and Pain Management, Dartmouth-Hitchcock Medical Center, Lebanon, NH; †Department of Anaesthesia, St Vincent's Hospital, and Melbourne Medical School, The University of Melbourne, Melbourne Victoria, Australia; and ‡The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Sites
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Barrington
authors.forename: Matthew
authors.initials: M
authors.lastname: Davis
mesh_terms: D000328:Adult; D000368:Aged; D019091:Critical Pathways / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D058996:Quality Improvement / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States