Quality Improvement Committee

Quality Improvement and Quality Assurance

Quality Improvement and Quality Assurance are now major concerns of every clinical department. At national and local levels, the specialty of anesthesiology, and specifically members of our Department have substantially contributed in the past, and continue to advance knowledge and applications of continuous improvement via the Departmental and Hospital QI Committees, and through contributions in such areas as setting national standards for sedation and development of training programs for hospital personnel. The DA QI Committee meets formally once/month and key members are available 24x7 to address emergent or urgent issues. Dr. Ellen Iannoli leads our QI Committee, assisted by Dr. Joseph Dooley, Dr. Russell Norton and Linda Phelan RN. The outline below presents the Committee functions and highlights three of the initiatives in process.

Committee Functions

1. Review all cases referred.
2. Triage cases. This is done by the committee chair or vice-chair.
3. Perform detailed review on all cases deemed to be worthy of further review during the triage process. This is done by Committee members who then prepare a detailed written evaluation.
4. Present reviewed cases for committee discussion at the monthly quality improvement Committee meeting.
5. Discuss relevant quality issues at the Committee meeting.
6. Lead monthly Quality Improvement Grand Rounds where issues of interest to the Department are presented and instructive cases are presented for the purpose of general education.
7. Represent the Department of Anesthesiology at the Perioperative Services Quality Council meeting.
8. Represent the Department of Anesthesiology at the SMH Joint Meeting Committee on the Quality of Care and Hospital Quality Assurance Committee.
9. Perform Root Cause Analyses as requested.

Initiatives

1. To enhance patient safety under emergent conditions requiring an airway or for future elective surgery, a "Difficult Airway Letter" initiative has been instituted for URMC. These letters are sent to all patients (and their PCPs) who were found to present possible airway problems related to a difficult intubation by members of the Department of Anesthesiology. We have developed a document describing the specific problem leading to the difficult intubation and presenting extubation recommendations based on that experience. This is to be placed in the patient's chart and have a bright color, so that it is easy to identify. Work is ongoing to have the patient's difficult intubation history placed in CIS with potential for wrist band identification immediately on arrival.
   
2. To enhance patient safety in the area of providing optimal pain relief without adverse respiratory or cardiovascular side effects, we are working on producing a teaching tool for floor nurses to discuss therapeutic options when using narcotics and approaches to rapid assessment and treatment of a medication that results in overdose.
3. To enhance rapid communication of new developments appreciated nationally or locally that could improve patient care and safety, the QI Committee will send a "Blitz E-mail" to all clinical staff informing them of any such developments well before the information may be available in the standard journals.
4. To enhance communication between patients and members of the Department of Anesthesiology to minimize misunderstandings and maximize the likelihood of a positive experience for each of our patients.
5. To coordinate our efforts with the Quality Assurance Committees of individual departments and those of Perioperative Services and all those at the institutional level.

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