title: Systematic Postoperative Nausea Prophylaxis Feedback Improves Clinical Performance in Anesthesiology Residents.
abstract: BACKGROUND
  Electronic medical records can generate a wealth of information regarding compliance with perioperative clinical guidelines as well as patient outcomes. Utilizing this information to provide resident physicians with measures of their own clinical performance may positively impact residents' clinical performance. We hypothesize that providing residents with objective measures of their individual adherence to evidence based postoperative nausea and vomiting (PONV) management protocols will improve their compliance with standardized treatment methods.
  
  
  METHODS
  We conducted a retrospective baseline analysis of junior anesthesiology residents' compliance with PONV prophylaxis guidelines for high-risk patients. This was followed by a prospective cohort study, before and after an educational intervention, a 15 minute lecture on PONV prophylaxis. The number of pharmacologic prophylactic interventions were tabulated for each operative case and reported back to individual residents in blind and anonymous fashion. The primary outcome was the use of two or more prophylactic interventions for a high-risk patient, while the secondary outcome was the use of three or more prophylactic interventions. A follow up survey was administered to participating residents regarding the use of their individualized clinical performance.
  
  
  RESULTS
  After implementation of feedback, patients received a significantly higher amount of PONV prophylactic treatments (p=0.001, means of 1.35 vs. 1.99). Comparison of percentage compliance was 38% vs 73%, respectively (p<0.001). In a follow up survey, residents received the feedback intervention well and had no significant concern in the dissemination of deidentified performance outcomes publically.
  
  
  CONCLUSIONS
  Resident compliance with PONV treatment guidelines was improved merely by auditing performance and providing individualized feedback. High-risk patients appear to receive more prophylactic agents after performance feedback and may be more effective than a more commonly used educational intervention to address the same topic. Providing direct performance feedback may be a useful tool for integration into graduate medical education programs.
authors.affiliation: Assistant Professor, Department of Anesthesiology and Pediatrics, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Nathaniel H
authors.initials: NH
authors.lastname: Greene
authors.affiliation: Resident Physician, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Norstedt
authors.affiliation: Research Associate Professor, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Bala G
authors.initials: BG
authors.lastname: Nair
authors.affiliation: Associate Professor and Vice Chair for Education, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Souter
keywords: electronic medical record; feedback; outcomes; quality improvement