Metrics to assess the quality of anesthesia, perioperative care, and acute pain management in Canada: a scoping review.

Abstract

Purpose: The aim of this scoping review was to consolidate a list of metrics that can be used to measure quality in anesthesiology, perioperative medicine, and acute pain management in Canada.

Methods: We included English-language full-text articles involving metrics (including patient-reported outcome and patient-reported experience measures, quality and safety indicators, and practice standards) for adults aged 18 yr and older undergoing inpatient non-cardiac surgery requiring an anesthesiologist. We searched MEDLINE®, Embase, CINAHL, Web of Science™, the Cochrane Database of Systematic Reviews, and grey literature to find articles on the topic from January 2015 to March 2022. In addition, we contacted 64 Canadian hospitals for existing anesthesia quality assurance and improvement metrics; they responded from June to October 2022. Two independent reviewers performed screening and data extraction. We grouped and condensed similar candidate metrics using thematic analysis.

Results: We assessed 4,493 publications, of which 63 met the inclusion criteria. We extracted 662 candidate metrics and consolidated them into 94 distinct metrics. Metrics reflected themes of perioperative management (n = 47), safety and standards (n = 23), patient-centredness (n = 11), intraoperative anesthetic care (n = 5), perioperative team leadership (n = 4), and efficiency (n = 4). Metrics spanned all quality-of-care categories (process, outcome, and structure) and perioperative phases but were limited by poor supporting evidence.

Conclusions: We consolidated a list of 94 metrics that can be used to evaluate the quality of anesthesia care. Further work will require verification of feasibility and validity prior to adoption, with operationalization of these metrics into practical indicators that are measurable and comparable.