QUALITY IMPROVEMENT
Managed care, or integration of the financing of health care and
the delivery of health care into one entity, in the United States has increased attention
on quality improvement. The Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) requires continuous quality improvement of hospitals. Quality improvement
is the effort to measure the level of current performance, find ways to improve that
performance, and implement new and better methods.[38]
Following these principles, a study at a university hospital quantified
the following customer requirements:
- Surgeons want on-time starts and low turnover times from anesthesiologists.
[57]
- Hospitals want anesthesiologists to reduce costs and unnecessary care.
Unnecessary variation erodes the quality of care.
- Patients want relief of pain, nausea, and vomiting (although each patient's
priority may vary).[58]
Teams of physicians, nurses, and other staff members may have
little knowledge of the practice of others. Clinical pathways, also called care
pathways or critical pathways, put providers caring for a patient "on the same page."
Clinical pathways are an application of continuous quality improvement to health
care. Hospitals are using clinical pathways to cut costs and reduce unnecessary
variation in care. These scientifically grounded, continuously reviewed treatment
strategies facilitate multidisciplinary communication, data collection, data analysis,
and feedback. In nonmedical sectors, simplification and standardization of production
processes to eliminate waste and duplication of effort have reduced costs.
Hospitals have tried to reduce anesthesia drug costs through written
guidelines. Limiting the use of neuromuscular blocking drugs, for instance, increased
the time from the end of surgery to PACU arrival by an average of 3 minutes.[59]
Although this finding was statistically significant, the effect on overall patient
throughput may be limited.
