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ECONOMICS, EDUCATION, AND POLICY

Changing Medical Group Behaviors: Increasing the Rate of Documentation of Quality Assurance Events Using an Anesthesia Information System

From the Center for Informatics and Perioperative Management, Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami/Jackson Medical Center, Florida.

Address correspondence and reprint requests to Michael M. Vigoda, MD, MBA, University of Miami/Jackson Memorial Hospital, Department of Anesthesiology, Perioperative Medicine, and Pain Management, 1611 NW 12th Ave. (C-300), Miami, FL 33136. Address e-mail to mvigoda{at}med.miami.edu.

Abstract

In the United States, quality assurance (QA) documentation is required by numerous agencies for each anesthetic performed. The goal of this study was to determine the effect of several interventions on the voluntary completion rate of QA documentation. We hypothesized that optimizing workflow integration would increase both QA completion rates and complication capture rates and promote long-term successful changes in reporting behavior. Whereas electronic scanning of anesthetic records may automate some aspects of QA, there will continue to be a need for anesthesiologists to enter QA documentation that cannot be automated. Starting from a baseline completion rate of 48%, we instituted a series of interventions. We successively increased the completion rate to 55% (education), 68% (workflow integration), and 78% (individual feedback). Each intervention increased the completion rate from the previous intervention (P < 0.001). The increased completion rate suggests better overall data capture, because the percentage of "no complication" entries decreased. After the study period, the completion rate increased to 94%, principally because of the improved workflow integration. As implementation of anesthesia information systems increases, attention to user interface design may be a key component in the functionality and utility of these systems.

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