title: Development and measurement of perioperative patient safety indicators.
abstract: BACKGROUND
  To improve perioperative patient safety, hospitals are implementing evidence-based perioperative safety guidelines. To facilitate this process, it is important to provide insight into current practice. For this purpose, we aimed to develop patient safety indicators.
  
  
  METHODS
  The RAND-modified Delphi method was used to develop a set of patient safety indicators based on the perioperative guidelines. First, a core group of experts systematically selected recommendations from the guidelines. Then, an expert panel of representative professionals appraised the recommendations against safety criteria, prioritized them and reached consensus about 11 patient safety indicators. Measurability, applicability, improvement potential (based on current practice) and discriminatory capacity of each indicator were pilot tested in eight hospitals.
  
  
  RESULTS
  Seven structure, two process and two outcome indicators were developed covering the entire perioperative care process. Most indicators showed good applicability (N=11), improvement potential (N=6) and discriminatory capacity (N=7). Four indicators were difficult to measure. Improvement opportunities concerned the use of perioperative stops, timely administration of antibiotics, availability of protocols on perioperative anticoagulants and on prospective risk analysis of medical equipment, presence of a surveillance system for postoperative wound infections, and a morbidity and mortality registration.
  
  
  CONCLUSIONS
  Using a systematic, stepwise method 11 patient safety indicators were developed for internal assessment, monitoring and improvement of the perioperative care process. There was large variation in guideline adherence between and within hospitals, identifying opportunities for improvement in the quality of perioperative care.
authors: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 114 IQ Healthcare, Nijmegen 6500 HB, The Netherlands Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Anaesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands yvette.emond@radboudumc.nl.
authors: Y E
authors: YE
authors: Emond
authors: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 114 IQ Healthcare, Nijmegen 6500 HB, The Netherlands.
authors: J J
authors: JJ
authors: Stienen
authors: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 114 IQ Healthcare, Nijmegen 6500 HB, The Netherlands.
authors: H C
authors: HC
authors: Wollersheim
authors: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 114 IQ Healthcare, Nijmegen 6500 HB, The Netherlands Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Anaesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands.
authors: G J
authors: GJ
authors: Bloo
authors: Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Anaesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands.
authors: J
authors: J
authors: Damen
authors: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 114 IQ Healthcare, Nijmegen 6500 HB, The Netherlands.
authors: G P
authors: GP
authors: Westert
authors: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors: M A
authors: MA
authors: Boermeester
authors: Knowledge Institute of Medical Specialists (Kennisinstituut van Medisch Specialisten), Utrecht, The Netherlands.
authors: M A
authors: MA
authors: Pols
authors: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 114 IQ Healthcare, Nijmegen 6500 HB, The Netherlands.
authors: H
authors: H
authors: Calsbeek
authors: Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Anaesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands.
authors: A P
authors: AP
authors: Wolff
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D032921:Consensus; D003697:Delphi Technique; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008991:Monitoring, Physiologic; D061214:Patient Safety / Q000592:standards*; D019990:Perioperative Care / Q000592:standards*; D010865:Pilot Projects; D011446:Prospective Studies; D058996:Quality Improvement; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants
keywords: guideline adherence; healthcare quality indicators; patient safety; perioperative care