Library resource guides: Perioperative medicine training resources: U1M14 Quality management processes

Guide index

Support resources

These resources appear throughout the module to support learning outcomes.

Recommended Texts

Recommended texts

National Safety and Quality Health Service Standards, 2e by Australian Commission on Safety and Quality in Health Care The National Safety and Quality Health Service (NSQHS) Standards were developed by the Australian Commission on Safety and Quality in Health Care (the Commission) in collaboration with the Australian Government, states and territories, the private sector, clinical experts, patients and carers. The primary aims of the NSQHS Standards are to protect the public from harm and to improve the quality of health service provision. They provide a quality assurance mechanism that tests whether relevant systems are in place to ensure that expected standards of safety and quality are met. There are eight NSQHS Standards, which cover high-prevalence adverse events, healthcareassociated infections, medication safety, comprehensive care, clinical communication, the prevention and management of pressure injuries, the prevention of falls, and responding to clinical deterioration. Importantly, these NSQHS Standards have provided a nationally consistent statement about the standard of care consumers can expect from their health service organisations.
ISBN: 978-1-922563-12-5
Publication Date: 2021

14.Quality Management Processes

Websites

American College of Surgeons. ACS Risk Calculator.
With this tool you can enter preoperative information about your patient to provide estimates regarding your patient's risk of postoperative complications.
Australian Commission on Safety and Quality in Health Care. Decision support tools for specific conditions.
Decision support tools can encourage shared decision making by informing discussions between clinicians and consumers.
NPS MedicineWise. Choosing Wisely.
Launched in Australia by NPS MedicineWise in 2015, in partnership with Australia's health professional colleges, societies and associations, Choosing Wisely Australia challenges the way we think about healthcare, questioning the notion 'more is always better'.

Other resources

Graphical Mini-Cog© form The graphical Mini-Cog was developed for rapid cognitive impairment screening in settings where a numerical score (0-5) is not required. The scoring system is the same as in the initial (Borson et al, 2000) proof-of-concept publication (see References). A pilot study conducted at the Cleveland Clinic (cited below) found that this version requires no training or prior exposure to administer and score with high accuracy.

Videos

Choosing Wisely Choosing Wisely - a parody of the infectious Pharrell Williams song "Happy" - choose wisely when it comes to making health care decisions and if you choose wisely it will make you happy.

LEGO Surgery - Enhanced Recovery After Surgery (ERAS is Awesome) In this episode Dr. Antrum helps patients Janey and Dan learn about ERAS (enhanced recovery after surgery) and how it could help them fast track through recovery.

Module references

The following are additional resources that participants may find useful to their studies.

Excess resources

Duceppe E, Parlow J, MacDonald P, et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery [published correction appears in Can J Cardiol. 2017 Dec;33(12 ):1735]. The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery.
Halvorsen S, Mehilli J, Cassese S, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022;43(39):3826-3924. Keywords: Anti-thrombotic therapy; Biomarkers; Guidelines; Non-cardiac surgery; Peri-operative beta-blockers; Peri-operative cardiac management; Peri-operative myocardial injury/infarction; Peri-operative treatment of arrhythmias; Post-operative cardiac surveillance; Pre-operative cardiac risk assessment; Pre-operative cardiac testing; Pre-operative coronary artery revascularization; Pre-operative treatment of valvular disease.

Gresham LM, et al. Evaluation of the effectiveness of an enhanced recovery after surgery program using data from the National Surgical Quality Improvement Program. Can J Surg. 2019 Jun;62(3):175–81. Full citation: Gresham LM, Sadiq M, Gresham G, McGrath M, Lacelle K, Szeto M, Trickett J, Schramm D, Pearsall E, McKenzie M, McLeod R, Auer RC. Evaluation of the effectiveness of an enhanced recovery after surgery program using data from the National Surgical Quality Improvement Program. Can J Surg. 2019 Jun;62(3):175–81.
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Abstract
Background: Barriers exist in implementing enhanced recovery after surgery (ERAS), which aims to decrease postoperative complication rates and length of stay, because perioperative care is varied and compliance from a multidisciplinary team is critical to success. The objectives of this project were to evaluate the effectiveness of the National Surgical Quality Improvement Program (NSQIP) database as a tool for the ongoing assessment of outcomes associated with ERAS and to evaluate ERAS as a quality-improvement strategy at a hospital-wide level. Methods: Adult patients who underwent an elective colorectal procedure at The Ottawa Hospital between March 2010 and September 2015 were included. Information on demographic characteristics, functional status, medical background, procedure details and hospital length of stay (LOS) was abstracted from the NSQIP database. We compared data on outcomes (LOS, postoperative complications, unplanned return visits to the emergency department and 30-day mortality) before and after ERAS. Results: We analyzed data for 609 patients (318 [52.2%] colon resection, 291 [47.8%] rectal resection; 190 [31.2%] before ERAS, 419 [68.8%] after ERAS). Significantly more patients were discharged within 5 days of surgery after ERAS than before (43.5% v. 29.1%, p < 0.05), and LOS more than 10 days was also reduced (23.7% v. 24.9%, p < 0.001). Implementation of ERAS was associated with an absolute reduction of 12% in postoperative complications and a significant reduction in surgical site infections among patients who underwent open procedures (p = 0.04). Conclusion: The introduction of an ERAS program for monitoring standardized perioperative care facilitates a data-driven approach to guide implementation of practice guidelines and establish the sustainability of ERAS protocols and data collection processes.
Vuk T, Qiu Y, Bust L, Strengers P, Seidl C. Quality monitoring and risk management in blood transfusion services. ISBT Science Series. 2018;13(3):2.84-289. [Access via Learn@ANZCA]
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Abstract
The safety and quality of blood and blood components are of essential value in transfusion medicine. It is a responsibility of blood establishments to organize their activities so that quality and safety requirements are met. The implementation and maintenance of an effective quality management system (QMS) will greatly contribute to the achievement of this goal. To be fully effective, a QMS should incorporate risk-based thinking in all aspects of the vein-to-vein transfusion process and include quality monitoring, which is carefully planned, continuous and properly evaluated. This study discusses several aspects of quality monitoring and risk management including their role, the importance thereof, objectives and implementation strategies. Quality monitoring is elaborated in detail with regard to quality indicators and quality control of blood components. In addition to describing general aspects of risk management in transfusion medicine, an example of its application is given on labelling of blood and blood components using the format of the EuBIS guide. Considering the biological origin of blood components and specific risks associated with their use, activities of quality monitoring and risk management in transfusion medicine should be strategic and proactive and not reactive.