Quality assurance in anesthesiology - The problem-oriented audit
The problem-oriented audit is an essential part of an adequate quality assurance program in anesthesiology. The problem-focused program involves identification of problems or concerns; definition of the cause and/or scope of the problem(s); actions taken to resolve the problem(s); monitoring to assure that actions taken are effective; and documentation of the overall effectiveness of the quality assurance program. Examples of problems that may be encountered in such a program include frequent cancellation of surgery; extended time sequences (e.g., prolonged induction of anesthesia, emergence from anesthesia, recovery room stay); blood pressure problems (hypotension or hypertension); prolonged neuromuscular blockade; postoperative infection associated with hyperglycemia in patients who have diabetes. Clinical performance should be measured by the use of preestablished criteria. These criteria are guidelines for high quality anesthesia care. Although anesthesiologists may choose alternate techniques and agents, violation of basic principles of optimal anesthesia care should not be tolerated.