Clarification of anesthesia standards and guidelines

Understanding and complying with the guidelines of the American Society of Anesthesiologists will help ensure high-quality patient care, increase levels of patient safety, and minimize medico-legal risk. The author discusses important standards and guidelines for the administration of general anesthesia and sedation/analgesia in the office-based setting and compares the requirements of the different accrediting organizations. (Aesthetic Surg J 2001;21:573-575.)     

Use of prophylactic antibiotics in surgical procedures: Peer review guidelines as a method for quality assurance

Concomitant with the development of guidelines for the use of prophylactic antibiotics in surgery, the Veterans Administration undertook a survey of its surgical chiefs in which the likelihood of peer review guidelines being an effective method of quality assurance was assessed. The scope of the present problem was also assessed in terms of the misuse of antimicrobial agents in surgical units. The implications of this study for quality assurance are: (1) Chiefs of surgery can be influenced by peer review guidelines, but other sources can also have impact. (2) The control practices used by chiefs to influence their staffs are limited. (3) The mechanisms used by chiefs to monitor adherence to their policies are mostly informal. The implications of this study in relation to surgical antibiotic prophylaxis are: (1) The practices of surgical chiefs differ significantly from peer review guidelines. (2) The problem is far more serious for certain surgical procedures than for others. (3) Most misuse errors are errors of commission rather than omission.     

From quality assurance to quality management. Applying data from quality assurance studies

The realization of internal and external surgical quality assurance is natural for hospital physicians. External influences on the hospital and a changed understanding of organisation demand a development of classical quality assurance. The primary aim is a patient orientated quality assurance related to the medical benefits and the patient individual needs. The active creation and establishing of functional organisation process and interprofessional and interdisciplinary structures in hospital setting is a requirement of time.     

Quality assurance that will ensure robust and transparent guidelines

The AGREE collaboration provides minimum quality standards for guidelines, yet none of the current wound-care guidelines acknowledge whether they fulfil these criteria. Only guidelines that comply with AGREE are likely to improve practice.     

Colonoscopic surveillance: quality,guidelines and effectiveness

Colonoscopic surveillance in patients with a personal or family history of colorectal carcinoma or colonic polyps represents a significant workload for endoscopy services. Effective colonoscopic surveillance relies on quality endoscopic examination and appropriate surveillance interval. This review will discuss quality in colonoscopy and review guidelines for surveillance.     

The evolution of guidelines toward standards of practice

The development of practice guidelines and its many synonyms has been the source of concern and a large amount of work in surgical specialty practice, especially over the last decade. These guidelines represent improvements and refinements. If they are strongly adhered to, standards of practice without consideration of outliers, physician judgment, and the man on the scene, then they have the capacity for great misunderstanding and harm. In general, I firmly believe that surgeons, their hospitals, and everybody involved in the process will find the preparation for transparency a positive experience, and that these guidelines, when properly assessed and refined by practicing surgical specialists, can become a strong asset not only for ourselves and our profession but also for our patients. In the future, guidelines must be carefully stated with specific exceptions and caveats. These guidelines need the respect, the careful judgment of the physician at the time and place, and the relative roles of a consultation and even second opinions. We must also be aware of the substantial capacity for influence of these standards by industry. A careful and ongoing analysis of the self-serving aspects of such work is essential. However, these observations and our work make the decision for elective surgical operations safer than it has ever been.     

Statistical analysis of quality assurance studies

A proposal for the multivariate analysis of quality control data is presented. This approach combines exact mathematical evaluation with great clarity of interpretation.     

The role of quality assurance versus continuous quality improvement

J Vasc Surg 1998;28:378-80.     

Parameters for predicting electromagnetic lithotripter failure: quality assurance implications

Despite the extensive use of lithotripsy for treating renal and biliary calculi, there has been little data reported regarding the causes and manifestations of lithotripter failure. The clinical and service records for 145 consecutive treatments performed with the Siemens Lithostar Plus were reviewed. Service record analysis revealed eight failures of shock wave generation during a 10-month period. Six of these failures were subtle and still allowed shock wave generation. There were five in-line ultrasound probe failures during this period. The most useful clinical parameter for predicting lithotripter failure was reduced severity of sonographically evident cavitation bubbles during treatment. Lack of stone fragmentation and unexpectedly low analgesia requirements at high-power levels were less useful in predicting lithotripter failure. All clinical parameters suffered from nonspecificity. Preliminary experience, with an ongoing quality assurance program using a test object hydrophone, suggests this is a useful method of predicting lithotripter function and avoiding compromised treatments.