anaesthesia and perioperative care

42 Pages·2016·2.21 MB·English

ANAESTHESIA AND
PERIOPERATIVE
CARE
VERSION 6
Retrospective data in full
ACIR 2008 - 2015
Contents

Anaesthesia and Perioperative Care, version 6 1
Pre-anaesthesia period ...................................................................................................................... 1
1.1 Pre-anaesthesia consultation completed by anaesthetist (H) 1
1.2 Smoking cessation advised in pre-anaesthesia consultation (H) 3
Intraoperative period.......................................................................................................................... 4
2.1 Presence of a trained assistant (H) 4
2.2 Anaesthesia record compliance with ANZCA requirements (H) 6
2.3 Time-out procedure: regional anaesthesia (H) 8
2.4 Prophylactic anti-emetic administered to patients with history of PONV (H) 9
Patient recovery period ................................................................................................................... 11
3.1 Relief of respiratory distress in the recovery period (L) 11
3.2 PONV treatment in the recovery period (L) 13
3.3 Temperature less than 36°C in the recovery period (L) 16
3.4 Severe pain not responding to pain protocol in the recovery period (L) 18
3.5 Unplanned stay in recovery room longer than 2 hours (L) 20
Postoperative period........................................................................................................................ 22
4.1 Unplanned ICU admission within 24 hours after procedure (L) 22
4.2 Documented patient handover - operating suite to recovery area (H) 23
4.3 Documented patient handover - recovery area to ward (H) 24
Management of acute pain .............................................................................................................. 25
5.1 Pain intensity scores recorded for surgical patients (H) 25
5.2 Daily anaesthetist review following postoperative epidural analgesia (H) 27
Obstetric anaesthesia care .............................................................................................................. 28
6.1 Obstetric patients experiencing post-dural puncture headache (L) 28
6.2 Obstetric patients with risks and benefits of analgesia documented (H) 30
Characteristics of contributing HCOs ............................................................................................ 32
Summary of Results 35
Pre-anaesthesia period 35
Intraoperative period 35
Patient recovery period 35
Postoperative period 36
Management of acute pain 36
Obstetric anaesthesia care 37
Expert Commentary 38
Australian and New Zealand College of Anaesthetists (ANZCA) ................................................. 38
Introductory comments 38
Pre-anaesthesia period 38
Intraoperative period 38
Patient recovery period 38
Postoperative period 39
Management of acute pain 39
Obstetric anaesthesia care 39
General/closing comments 40
Australasian Clinical Indicator Report 2008–2015
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Anaesthesia and Perioperative Care, version 6
Pre-anaesthesia period
1.1 Pre-anaesthesia consultation completed by anaesthetist (H)
Rationale
Consultation by an anaesthetist is essential for the medical assessment of a patient prior to
anaesthesia for surgery or other procedures, to ensure that relevant risks have been identified,
appropriately managed and communicated. The consultation must take place at an appropriate time
and place prior to anaesthesia and surgery in order to allow for adequate consideration of all factors.
Pre-anaesthesia consultation facilities must include appropriate equipment and space to allow for a
consultation and clinical examination in privacy. An appropriately equipped consulting room or single
bed hospital room is most appropriate. Consent for anaesthesia is a separate process from consent
for surgical procedures. Information about anaesthesia and procedural risks are a necessary part of
the pre-anaesthesia consultation process.
Number of patients who have documentation of risks and benefits of the anaesthetic
procedure(s) completed by an anaesthetist prior to transfer to the operating suite or
Numerator procedure room.
Denominator Number of patients who undergo a procedure with an anaesthetist in attendance.

Desirable level:  Low  High  Not specified
Type of Indicator:  Process  Outcome  Structure

No. Total Total Rate# Rate# Centile Stratum Outlier
Year HCOs numerator denominator Rate# (20) (80) Gains Gains Gains
2015 41 74,103 76,741 96.6 99.9 100 2,636 2,534 2,248
# per 100 patients
In 2015, there were 66 records from 41 HCOs. The annual rate was 96.6 per 100 patients.
Variation between strata
Rates by Public / Private
No. Total Total Stratum Standard Stratum
Year Stratum HCOs numerator denominator rate# error gains
2015 Private 26 36,170 36,218 99.9 1.66
Public 15 37,933 40,523 93.6 1.57 2,534
# per 100 patients
Boxplot of Rates by Public / Private

Australasian Clinical Indicator Report 2008–2015 Page 1
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Anaesthesia and Perioperative Care, version 6

Variation between HCOs
There was relatively little variation between HCOs and so the potential gains were small in 2015.
Outliers
In 2015, there were eight outlier records from six outlier HCOs whose combined excess was 2,248
fewer patients who have complying documentation of risks and benefits of the anaesthetic
procedure(s) at consultation. The outlier HCO rate was 74.2 per 100 patients.
Funnel plot of excess events

Australasian Clinical Indicator Report 2008–2015 Page 2
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Anaesthesia and Perioperative Care, version 6
1.2 Smoking cessation advised in pre-anaesthesia consultation (H)
Numerator Number of patients who are smokers and have documented quit smoking advice recorded as
part of their pre-anaesthesia consultation.
Denominator Number of patients who are smokers and have a pre-anaesthesia consultation.
Desirable level:  Low  High  Not specified
Type of Indicator:  Process  Outcome  Structure
No. Total Total Rate# Rate# Centile Stratum Outlier
Year HCOs numerator denominator Rate# (20) (80) Gains Gains Gains
2015 4 3,852 3,856 99.9 98.6 100 4 2
# per 100 patients who smoke
In 2015, there were seven records from four HCOs. The annual rate was 99.9 per 100 patients who
smoke.
Variation between strata
There were no significant stratum differences in 2015.
Variation between HCOs
There was relatively little variation between HCOs and so the potential gains were small in 2015.
Outliers
In 2015, there was one outlier record from one outlier HCO whose combined excess were two
fewer smokers who have documented quit smoking advice recorded at consultation. The outlier
HCO rate was 98.4 per 100 patients who smoke.
Australasian Clinical Indicator Report 2008–2015 Page 3
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Anaesthesia and Perioperative Care, version 6

Intraoperative period
2.1 Presence of a trained assistant (H)
Rationale
The presence of a trained assistant for the anaesthetist during the conduct of anaesthesia is a major
contributory factor to safe patient management. An adequate anaesthesia record is an essential part
of the patient’s medical record and should document all aspects of management relevant to the
anaesthetic. Postoperative nausea and vomiting (PONV) is a frequent and distressing consequence
of many surgical procedures. There is a wealth of literature highlighting known risk factors, and
international consensus guidelines for prophylaxis.
Numerator Number of patients who undergo a procedure with an anaesthetist in attendance, where there
is a trained assistant to the anaesthetist.
Denominator Number of patients who undergo a procedure with an anaesthetist in attendance.

Desirable level:  Low  High  Not specified
Type of Indicator:  Process  Outcome  Structure

No. Total Total Rate# Rate# Centile Stratum Outlier
Year HCOs numerator denominator Rate# (20) (80) Gains Gains Gains
2010 33 121,751 123,053 98.9 100 100 1,301 1,007
2011 37 159,484 166,685 95.7 100 100 7,200 6,925 6,135
2012 39 165,889 173,162 95.8 100 100 7,272 6,951 6,349
2013 38 167,391 180,507 92.7 99.5 100 13,114 9,510 9,946
2014 34 125,143 136,555 91.6 98.8 100 11,409 8,548
2015 32 138,852 141,484 98.1 100 100 2,631 2,632 2,208
# per 100 patients
In 2015, there were 53 records from 32 HCOs. The annual rate was 98.1 per 100 patients.
Trends
The fitted rate deteriorated from 96.5 to 94.0, a change of 2.6 per 100 patients.
Trend plot of rates and centiles by year
A High rate is desirable
80th centile rate
x Aggregate rate
Period average rate
Fitted rate
20th centile rate

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Variation between strata
Rates by State
No. Total Total Stratum Standard Stratum
Year Stratum HCOs numerator denominator rate# error gains
2015 NSW 13 56,383 56,383 100 1.01
Qld 6 14,282 14,282 100 2.00
Other 13 68,187 70,819 96.3 0.90 2,632
# per 100 patients
Boxplot of Rates by State

Variation between HCOs
There was relatively little variation between HCOs and so the potential gains were small in 2015.
Outliers
In 2015, there were three outlier records from two outlier HCOs whose combined excess was 2,208
fewer procedures where there is a trained assistant to the anaesthetist. The outlier HCO rate was
86.8 per 100 patients.
Funnel plot of excess events

Australasian Clinical Indicator Report 2008–2015 Page 5
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Anaesthesia and Perioperative Care, version 6

2.2 Anaesthesia record compliance with ANZCA requirements (H)
Numerator Number of patients who undergo a procedure with an anaesthetist in attendance, where the
anaesthesia record substantially complies with the ANZCA requirements for the anaesthetic
record.
Denominator Number of patients who undergo a procedure with an anaesthetist in attendance.

Desirable level:  Low  High  Not specified
Type of Indicator:  Process  Outcome  Structure

No. Total Total Rate# Rate# Centile Stratum Outlier
Year HCOs numerator denominator Rate# (20) (80) Gains Gains Gains
2008 69 112,500 117,301 95.9 94.1 100 4,785 3,481
2009 60 112,909 115,913 97.4 94.1 100 2,994 2,178 2,174
2010 67 120,676 124,375 97.0 94.1 100 3,691 2,798
2011 68 188,207 192,218 97.9 99.5 100 4,007 3,137
2012 63 158,280 163,568 96.8 99.2 100 5,283 2,525 4,080
2013 61 159,604 163,246 97.8 98.8 100 3,635 1,458 2,507
2014 58 147,316 150,630 97.8 98.5 100 3,309 2,389
2015 52 122,852 124,093 99.0 99.2 100 1,237 978
# per 100 patients
In 2015, there were 94 records from 52 HCOs. The annual rate was 99.0 per 100 patients.
Trends
The fitted rate improved from 96.3 to 98.3, a change of 2.0 per 100 patients.
Trend plot of rates and centiles by year
A High rate is desirable
80th centile rate
x Aggregate rate
Period average rate
Fitted rate
20th centile rate

Variation between strata
There were no significant stratum differences in 2014 and 2015.
Variation between HCOs
There was relatively little variation between HCOs and so the potential gains were small in 2015.

Australasian Clinical Indicator Report 2008–2015 Page 6
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Outliers
In 2015, there were 12 outlier records from 10 outlier HCOs whose combined excess was 978 fewer
compliant anaesthesia records. The outlier HCO rate was 91.5 per 100 patients.
Funnel plot of excess events

Australasian Clinical Indicator Report 2008–2015 Page 7
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Anaesthesia and Perioperative Care, version 6

2.3 Time-out procedure: regional anaesthesia (H)
Numerator Number of patients who have documented time out procedure addressing laterality for
regional anaesthesia.
Denominator Number of patients receiving regional anaesthesia, with or without general anaesthesia.

Desirable level:  Low  High  Not specified
Type of Indicator:  Process  Outcome  Structure

No. Total Total Rate# Rate# Centile Stratum Outlier
Year HCOs numerator denominator Rate# (20) (80) Gains Gains Gains
2015 6 6,792 6,847 99.2 99.9 100 55 47
# per 100 patients
In 2015, there were eight records from six HCOs. The annual rate was 99.2 per 100 patients.
Variation between strata
There were no significant stratum differences in 2015.
Variation between HCOs
There was relatively little variation between HCOs and so the potential gains were small in 2015.
Outliers
In 2015, there was one outlier record from one outlier HCO whose combined excess was 47 fewer
patients who have time out procedure documented. The outlier HCO rate was 94.5 per 100 patients.
Australasian Clinical Indicator Report 2008–2015 Page 8
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