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Perioperative Quality Improvement
- 1st Edition - July 30, 2022
- Editors: Carol J. Peden, Lee A. Fleisher, Michael Englesbe
- Language: English
- Paperback ISBN:9 7 8 - 0 - 3 2 3 - 8 3 3 9 9 - 8
- eBook ISBN:9 7 8 - 0 - 3 2 3 - 8 3 4 0 1 - 8
- eBook ISBN:9 7 8 - 0 - 3 2 3 - 8 3 4 0 0 - 1
Quality improvement (QI) principles are increasingly important in every area of today’s healthcare, encompassing efforts to make healthcare delivery safer, more effective, pa… Read more
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Request a sales quoteQuality improvement (QI) principles are increasingly important in every area of today’s healthcare, encompassing efforts to make healthcare delivery safer, more effective, patient-centered, timely, equitable, and efficient. Perioperative Quality Improvement provides up-to-date, easy-to-read guidance for perioperative clinicians on this critical topic. Each chapter covers a pertinent area of QI in the perioperative setting, focusing on both concepts and implementation. Written and edited by key international opinion leaders in the field, this text is a relevant, concise resource for anesthesiologists, surgeons, nurse anesthetists, and hospitalists—anyone involved in perioperative medicine regardless of specialty area.
- Explains concepts related to understanding the tools and techniques used in improving the quality of care, establishing a culture of quality, prioritizing areas of improvement, collecting and analyzing data, communicating, motivating people to change, and performing ongoing evaluations.
- Covers key topics such as patient-centered care, equity, shared decision making, process mapping, and sustainability.
- Addresses the critical areas of structure, process and outcome with a focus on perioperative care and relevant case studies.
- Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.
anesthesiologists, surgeons, nurse anesthetists, hospitalists
- Cover
- Title page
- Table of Contents
- Copyright
- Contributors
- Foreword
- Preface
- Section 1: Background
- Chapter 1: What Is Quality in Medicine and Why Do We Need to Work on It?
- Abstract
- Defining Quality in Health Care
- A System of High-Quality Care
- Delivering Quality in Health Care
- References
- Chapter 2: Where Does Safety Fit In?
- Abstract
- National Health Service Patient Safety Strategy
- Patient Safety Culture
- Patient Safety Systems
- Insight
- Involvement
- Improvement
- References
- Chapter 3: What Is Perioperative Medicine and Why Do We Need It?
- Abstract
- Introduction
- Background
- Perioperative Medicine/Care
- Conclusion
- References
- Chapter 4: The Case for Improvement in Perioperative Medicine
- Abstract
- Introduction
- Increasing Healthcare Costs and Poor Outcomes
- Addressing the Gap Through Innovations in Perioperative Care
- Conclusion
- References
- Chapter 5: The Promise and Pitfalls of Big Data Studies in Perioperative Medicine
- Abstract
- “Big Data” Studies and Perioperative Clinical Equipoise
- Perioperative Medicine Registries, Big Data, and Future Directions
- Assessing the Quality of Big Data Research
- Machine Learning as a Powerful Tool, Not a Panacea
- The Emerging Future of Perioperative Medicine Integrates Big Data and Prospective Trials
- Conclusion
- References
- Chapter 6: Clinical Trials in Perioperative Medicine
- Abstract
- The Importance of Clinical Trials
- Research as Evidence
- Useful Clinical Trials: When to Change Practice
- Real-World Examples
- Conclusions
- References
- Chapter 7: Large-Scale Audits: Using Citizen Science to Gather High-Quality “Big Data”
- Abstract
- Why Is This Important in Perioperative Medicine?
- What Is Citizen Science?
- How Has Citizen Science Been Applied in Health Care?
- Practical Guidance
- References
- Chapter 8: Education in Perioperative Medicine
- Abstract
- Perioperative Education
- References
- Chapter 9: System Thinking in Perioperative Medicine
- Abstract
- Complexity in Medicine
- What Is a System?
- What Is System Thinking?
- How to Do It: Key Concepts
- Healthcare Improvements Via System Thinking
- Why Now in Perioperative Medicine?
- Conclusion
- References
- Further Reading and Resources
- Chapter 10: Patient-Centered Care in Perioperative Outcomes
- Abstract
- What Is Patient-Centered Care?
- How Do We Measure Success?
- References
- Chapter 11: Shared Decision Making
- Abstract
- Introduction
- Origins and Drivers
- Benefits of Shared Decision Making
- Barriers to Shared Decision Making
- Practical Guidance
- Summary
- References
- Chapter 12: Clinical Outcomes and Measures in Perioperative Care
- Abstract
- Importance of Clinical Outcome Measures
- Clinical Outcome Measures to Use in Perioperative Care
- Improving Perioperative Care With Clinical Outcome Measures
- References
- Chapter 13: Equity and Perioperative Care
- Abstract
- Understanding Health Equity
- Addressing Implicit Bias
- Designing for Health Equity
- What Perioperative Care Professionals Can Do to Address Health Equity
- References
- Chapter 14: Qualitative Research in Perioperative Medicine
- Abstract
- Qualitative Research in Perioperative Medicine
- What Is Qualitative Research, and What Kinds of Questions Can It Answer?
- Data Collection
- Data Analysis
- Explanation
- Moving Forward
- References
- Chapter 15: Publication in Perioperative Medicine
- Abstract
- Introduction
- Perioperative Population Health Management: A Current Overarching Theme and Important Driver
- Three Key Perspectives That Warrant Further Research and Publication Emphasis
- Health Services Research and Quality Improvement Research
- Increasing the Likelihood of Successful Publication
- References
- Chapter 16: The SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) Guidelines: A Framework for Designing and Reporting Quality Improvement Studies, Application in Perioperative Care
- Abstract
- Background
- Planning Your Study: Why Did You Start?
- Methods: What Did You Do?
- Results: What Did You Find?
- Discussion: What Does It Mean?
- Examples of Studies That Use SQUIRE 2.0 Guidelines
- Conclusions
- References
- Chapter 17: Leveraging the Perioperative Period to Address Population Health
- Abstract
- Introduction
- Surgery as a Teachable Moment and Missed Opportunity
- Current Examples
- A Conceptual Model to Address Population Health Issues in the Perioperative Period
- References
- Chapter 18: Building for Sustainability
- Abstract
- Introduction
- Shared Purpose
- Improvement Methodology and Project Management
- Measurement
- System Drivers
- Mobilize and Engage
- Leadership
- Spread and Adoption
- References
- Chapter 19: Risk Management and Perioperative Quality
- Abstract
- Medical Malpractice as Deterrence: A Failed Approach to Quality and Patient Safety
- Practical Strategies for Risk Reduction
- Improving Communication Skills
- Educating Surgeons on Medical Malpractice
- Enhancing Informed Consent
- Conclusions and Summary
- References
- Chapter 20: Using Innovative Payment Models to Drive Improvement in Perioperative Care
- Abstract
- Healthcare Spending in the United States
- Why Is Payment Reform Important in Perioperative Medicine?
- Payment Models With Provider-Focused Incentives
- Payment Models With Patient-Focused Incentives
- References
- Section 2: Improvement Science Tools for Change
- Chapter 21: What is Program Theory and Why Is It Important to Perioperative Quality Improvement?
- Abstract
- Introduction: What Is Program Theory?
- Why Use Program Theory in Perioperative Quality Improvement?
- Developing a Program Theory
- Identify What Is Needed to Support the Improvement Activity
- Conclusion
- References
- Chapter 22: An Overview of Common Improvement Methodologies and Their Background
- Abstract
- Six Sigma and Lean Thinking
- Model for Improvement
- Statistical Process Control
- Theory of Constraints
- Summary
- References
- Chapter 23: The Model for Improvement: A Tool to Drive Perioperative Improvement
- Abstract
- Background
- The Model for Improvement: The Theory
- The Model for Improvement: The Practice
- Summary
- References
- Chapter 24: Lean in Health Care
- Abstract
- References
- Other Reading
- Chapter 25: Other Performance Improvement Tools: From Compliance to Excellence
- Abstract
- ISO 9001 Quality Management System
- Six Sigma
- Baldrige Criteria for Performance Excellence
- European Foundation for Quality Management
- References
- Chapter 26: Building a Measurement System That Works: Milestones, Measure Development, and Sampling
- Abstract
- Moving From Concept-Land to Measurement-Land
- References
- Chapter 27: Analyzing Variation With Run Charts
- Abstract
- What Is a Run Chart?
- Elements of a Run Chart
- Analyzing a Run Chart
- References
- Further Reading
- Chapter 28: Statistical Process Control Charts for Clinical Users
- Abstract
- Displaying 30-Day Readmission Rates Using a P-Chart
- Displaying Postsurgical Pain Scores Using an I-Chart
- Displaying Occurrences of Hematoma After Breast Augmentation Surgery Using a G-Chart
- References
- Chapter 29: Process Mapping
- Abstract
- Background
- To Create a Process Map
- References
- Further Reading
- Chapter 30: Driver Diagrams
- Abstract
- Introduction
- Creating a Driver Diagram
- Using a Driver Diagram
- Conclusion
- References
- Chapter 31: Care Bundles for Perioperative Improvement
- Abstract
- Background
- Why Do Bundles Work?
- Examples of Bundle Application in Perioperative Care
- ABCDEF Bundle in Intensive Care
- What Care Bundles Are Not?
- Meta-Analysis
- References
- Chapter 32: Human Factors in Perioperative Care: General Principles
- Abstract
- What Do We Mean by Human Factors?
- Standard Human Factors Approach to Analysis of Work
- Approach to Improvement
- Focus on Humans
- Safety I and Safety II: Humans as the Solution
- References
- Chapter 33: Human Factors and Perioperative Improvement: Handover Checklists and Protocols for Safe and Reliable Care Transitions
- Abstract
- Handover Checklists
- Handover Protocols
- References
- Chapter 34: Checklists for Safer Perioperative Care
- Abstract
- Why Is This Important In Perioperative Medicine?
- Evidence Base, Discussion, and Important Relevant References
- Practical Guidance
- References
- Chapter 35: Social Aspects of Change in Perioperative Care and the Importance of Context
- Abstract
- Social Aspects of Change in Perioperative Care and the Importance of Context
- Context and Perioperative Improvement
- Making Sense of Social and Contextual Influences on Perioperative Improvement
- Practical Implications
- References
- Chapter 36: Stakeholder Engagement
- Abstract
- Acknowledgments
- Foundational Always Events
- Team Design—More Than Stakeholders
- Mental Rehearsal—More Than Finding a Meeting Time and Agenda
- Continuous Engagement
- Pulling it Together
- The Ultimate Stakeholder: The Patient
- References
- Chapter 37: Techniques for Creating Urgency
- Abstract
- Acknowledgments
- S: Stories
- T: Temperature
- A: Action
- T: Tempo
- References
- Chapter 38: Leadership in Perioperative Quality
- Abstract
- Leadership and Change Management
- Leadership and Innovation
- Psychological Safety
- Summary
- References
- Chapter 39: Establishing and Running Quality Collaboratives: The Michigan Experience
- Abstract
- Funding of the Collaborative Portfolio
- Establishing Trust
- Setting the Quality Improvement Agenda With Good Data
- Leveraging Incentives
- Summary
- References
- Chapter 40: Excellent Perioperative Patient Experience
- Abstract
- A Brief History of Patient Experience
- What Matters to Patients
- How to Improve
- References
- Chapter 41: An International Perspective on Training and Setting Standards in Perioperative Medicine
- Abstract
- The Importance of Training and Standards in Perioperative Medicine
- References
- Section 3: Putting It All Together—Clinical Quality Improvement Examples
- Chapter 42: Implementation of Enhanced Recovery for Colorectal Surgery: A Real-World Example of Quality Improvement
- Abstract
- Acknowledgments
- Introduction
- Methods
- Results
- Discussion
- Conclusion
- References
- Chapter 43: Quality Improvement Through the Lens of the Multicenter Perioperative Outcomes Group
- Abstract
- Acknowledgments
- Introduction
- Context
- Example A: Perioperative Transfusion Stewardship
- Example B: Improving Environmental Sustainability in the Operating Room
- Summary
- References
- Chapter 44: The Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications From Kidney Stones (ROCKS) Quality Initiative
- Abstract
- Introduction
- The Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications From Kidney Stones (ROCKS) Framework
- Understanding the Problem
- Enact Change
- Measuring the Outcomes
- Limitations
- Conclusions
- Funding
- References
- Chapter 45: Enhanced Recovery After Surgery Protocols— Implementation Across a US Health System: System-Level Principles
- Abstract
- Introduction
- ERAS Implementation Across a US Health System
- Organizing Around the Health System Model
- Vertical and Horizontal Implementation Model
- Setting Quality Standards for Perioperative Pathways
- ERAS by Care Phase
- Electronic Medical Record and Order Sets
- Measuring Compliance and Outcomes
- Summary
- References
- Chapter 46: Pain Care Pathways and Patient Reported Outcomes
- Abstract
- Introduction
- Plan—Listen to Operationally Minded Clinical Experts
- Do—Include As Many Stakeholders As You Can
- Check—Most Importantly, With the Patient
- Adjust and Sustain—Informed By Data
- Results
- Change Within the State
- References
- Chapter 47: Health Services Research
- Abstract
- Introduction to Health Services Research
- Common Study Designs
- Applications of Study Designs
- Reporting of Health Services Research
- Differences Between Quality Improvement and Research
- Summary
- References
- Chapter 48: The Perioperative Brain Health Initiative
- Abstract
- Introduction
- Brain Health Initiative—Actions
- Results
- Discussion
- Conclusions
- References
- Chapter 49: Quality Improvement in Emergency Surgery: Learning From Two Large-Scale Programs to Reduce Mortality After Emergency Laparotomy
- Abstract
- Background
- EPOCH and the ELC: Summary of the Studies and the Main Findings
- Key Learning From These Studies
- Conclusion
- References
- Chapter 50: Perioperative Quality Improvement Programme
- Abstract
- Why Did We Do This Work?
- Establishing PQIP
- Results
- Discussion
- References
- Chapter 51: Using Real-World Data for Improvement—The Seattle Children's Example
- Abstract
- Introduction
- Methods
- Results
- Discussion
- References
- Chapter 52: Optimizing Value in Perioperative Medicine and the High Value Practice Academic Alliance: A Case-Based Study on Preoperative Assessment
- Abstract
- Clinical Case Example
- Case Review
- Discussion
- Training for “Value” in the High Value Practice Academic Alliance
- References
- Further Reading and Resources
- Chapter 53: Perioperative Medicine for Older People: Translating a Geriatrician-Led Perioperative Care Model From an Inner London Teaching Hospital to a District General Hospital
- Abstract
- Introduction: The Need for Geriatrician-Led Perioperative Services
- Context: Establishment of POPS Service, Evidence Base, and Scaling Challenges
- Intervention
- Analysis and Ethics
- Results
- Sustainability
- Discussion
- References
- Chapter 54: Putting It All Together: Clinical Quality Improvement Examples: Agency for Healthcare Research and Quality, Improving Surgical Care and Recovery
- Abstract
- Why Did We Do This Work—Clinical Issues and Background
- Data Sources and Outcomes
- Results
- Discussion
- References
- Chapter 55: Cardiovascular Disease: Preoperative Testing and Evaluation for Noncardiac Surgery
- Abstract
- Introduction
- Risk Assessment
- Perioperative Evaluation
- Testing/Evaluation/Management
- References
- Further Reading
- Chapter 56: Orthopedics and Regional Anesthesia: An Outpatient Total Shoulder Replacement Pathway
- Abstract
- Acknowledgments
- Background
- Creation of the Outpatient Total Shoulder Replacement Pathway
- Results
- Discussion
- References
- Chapter 57: A Case Study: National Emergency Laparotomy Audit
- Abstract
- Introduction
- Methods
- Discussion
- Limitations
- Conclusion
- References
- Chapter 58: Provider Resilience and Caring for the Carer
- Abstract
- Background
- Burnout, Resilience, and the Quality and Safety of Health Care
- Creating a Culture of Resilience, Wellness, and “Joy in Work”
- Development of a Local Intervention
- Discussion
- References
- Chapter 59: Nursing and Perioperative Quality Improvement
- Abstract
- Introduction
- What Is a Perioperative Nurse?
- What Is the Role of the Nurse in Perioperative Quality Improvement?
- References
- Chapter 60: Certified Registered Nurse Anesthetists and Perioperative Medicine
- Abstract
- The Certified Registered Nurse Anesthetist Lens
- Implementation of Perioperative Medicine: The CRNA Perspective
- Example 1: “Being Part of the Bigger Picture”
- Example 2: “Drive to Excellence”
- Example 3: “Lead by Leading”
- Conclusion
- References
- Chapter 61: Environmental Sustainability and Perioperative Quality Improvement
- Abstract
- Introduction
- Environmental Sustainability
- Climate Change
- Measures and Approaches
- Discussion
- References
- Further Reading
- Chapter 62: Gaining and Keeping C-Suite Support for Perioperative Quality Improvement Initiatives
- Abstracts
- A Personal Perspective
- Walk in Our Shoes: Understanding the CEO Role
- What Keeps Healthcare CEOs Awake at Night
- What CEOs Want to See in a Performance Improvement Initiative Proposal
- Eight Tips for Successful CEO Meetings
- References
- Suggested Reading
- Index
- No. of pages: 448
- Language: English
- Edition: 1
- Published: July 30, 2022
- Imprint: Elsevier
- Paperback ISBN: 9780323833998
- eBook ISBN: 9780323834018
- eBook ISBN: 9780323834001
CP
Carol J. Peden
Carol J. Peden is an Adjunct Profesor in Anesthesiology at both the Keck School of Medicine of USC in Los Angeles, California and the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, Pennsylvania. She is also a Visiting Professor at the Centre for Healthcare Innovation and Improvement, University of Bath in Bath, Somerset, UK.
LF
Lee A. Fleisher
Affiliations and expertise
Robert Dunning Drips Professor and Chair of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.ME
Michael Englesbe
Michael Engelsbe is the Cyrenus G. Darling Sr., MD and Cyrenus G. Darling Jr., MD Professor of Surgery within the Section of Transplantation Surgery at Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
Affiliations and expertise
Cyrenus G. Darling Sr. & Cyrenus G. Darling Jr. Professor of Surgery, University of Michigan, Ann Arbor, Michigan, USA