[Perioperative monitoring of the course of anesthesia, the postanesthesia visit and inquiry of patient satisfaction. A prospective study of parameters in process and outcome quality in anesthesia]

Abstract

Purpose: This study is an investigation into the results of reporting on incidents during and after anaesthesia, to reveal any possible associations between intra-procedural and final outcome. The study contributes to the quality assurance project of the German Society of Anaesthesiology and Intensive Care (DGAI). We adjusted and tabulated our data for preoperative risk and for different methods of anaesthesia. This nation-wide DGAI project was launched to compare clinical institutions in accordance with German social legislation.

Method: DGAI recommends standardised documentation of parameters representing quality of process (QP) defined by a 63-items list, during every anaesthesia course. Additionally, quality of outcome parameters (QO) defined by a 64-items list should be assessed by an anaesthetist during a standardised postoperative ward round by means of spot checks. A questionnaire covering subjective complaints (SC) and patient satisfaction, is optional. The combination of these tools was evaluated during a 5-month period in every patient (n = 282) on a traumatological surgery ward.

Results: QP and QO showed a significant association (p < 0.0001). The incidence of both parameters increases according to risk factors like age and ASA physical status. This was not significant in respect of the type of anaesthesia (p = 0.20). Whereas perioperative QP parameters were less frequent in regional versus general anaesthesia (p < 0.0001), there was no postoperative difference in QO as seen by the anaesthetist (p = 0.20). However, postoperative SC were less frequent with regional anaesthesia (p < 0.0001). The association of QO and SC was mot significant (p = 0.24). There was comparable preoperative morbidity (p = 0.74) for both anaesthetic procedures. 96.5% of all patients expressed overall satisfaction. Despite this fact, nausea (25%), vomiting (29%), thurst (29%) and particularly wound pain (33%) were frequent.

Conclusions: Quality parameters assessed by anaesthetists and patients are independent in respect to their frequency. For this purpose, anaesthesiological quality assurance must focus on both the anaesthetist and the patient. As clinical consequence, we suggest establishing an interdisciplinary post-anaesthesia service. Acceptance by, and collaboration between, the surgical disciplines are indispensable especially for a successful application of effective pain and antiemetic therapy.