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Perioperative structure and process quality and safety indicators: a systematic review

Perioperative structure and process quality and safety indicators: a systematic review
Perioperative structure and process quality and safety indicators: a systematic review

Background: Clinical indicators assess healthcare structures, processes, and outcomes. While used widely, the exact number and level of scientific evidence of these indicators remains unclear. The aim of this study was to evaluate the number, type, and evidence base of clinical process and structure indicators currently available for quality and safety measurement in perioperative care. Methods: We performed a systematic review searching Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Google Scholar, and System for Information in Grey Literature in Europe databases for English language human studies in adults (age >18) published in the past 10 years (January 2005–January 2016). We also included professional and governmental body publications and guidelines describing the development, validation, and use of structure and process indicators in perioperative care. Results: We identified 43 860 journal articles and 43 relevant indicator program publications. From these, we identified a total of 1282 clinical indicators, split into structure (36%, n=463) and process indicators (64%, n=819). The dimensions of quality most frequently addressed were effectiveness (38%, n=475) and patient safety (29%, n=363). The majority of indicators (53%, n=675) did not have a level of evidence ascribed in their literature. Patient-centred metrics accounted for the fewest published clinical indicators. Conclusions: Despite widespread use, the majority of clinical indicators are not based on a strong level of scientific evidence. There may be scope in setting standards for the development and validation process of clinical indicators. Most indicators focus on the effectiveness, safety, and efficiency of care. PROSPERO database: CRD4201501277.

healthcare, perioperative period, quality indicators, review, systematic
0007-0912
51-66
Chazapis, M.
93c98cd3-b292-4582-ada1-d35b6e927092
Gilhooly, D.
c3c883ef-67f2-465b-acad-0a6b2a052b82
Smith, A.F.
630156c1-f15a-48e9-8ab0-9b9cda37c47f
Myles, P.S.
33760c6d-ba95-4948-8d8f-43be43aad3f5
Haller, G.
aa094ca6-53ec-460d-b248-b471ae8102c6
Grocott, M.P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Moonesinghe, S.R.
2461cb46-56a1-4795-bd9b-0f30e65d6a32
Chazapis, M.
93c98cd3-b292-4582-ada1-d35b6e927092
Gilhooly, D.
c3c883ef-67f2-465b-acad-0a6b2a052b82
Smith, A.F.
630156c1-f15a-48e9-8ab0-9b9cda37c47f
Myles, P.S.
33760c6d-ba95-4948-8d8f-43be43aad3f5
Haller, G.
aa094ca6-53ec-460d-b248-b471ae8102c6
Grocott, M.P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Moonesinghe, S.R.
2461cb46-56a1-4795-bd9b-0f30e65d6a32

Chazapis, M., Gilhooly, D., Smith, A.F., Myles, P.S., Haller, G., Grocott, M.P.W. and Moonesinghe, S.R. (2018) Perioperative structure and process quality and safety indicators: a systematic review. British Journal of Anaesthesia, 120 (1), 51-66. (doi:10.1016/j.bja.2017.10.001).

Record type: Review

Abstract

Background: Clinical indicators assess healthcare structures, processes, and outcomes. While used widely, the exact number and level of scientific evidence of these indicators remains unclear. The aim of this study was to evaluate the number, type, and evidence base of clinical process and structure indicators currently available for quality and safety measurement in perioperative care. Methods: We performed a systematic review searching Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Google Scholar, and System for Information in Grey Literature in Europe databases for English language human studies in adults (age >18) published in the past 10 years (January 2005–January 2016). We also included professional and governmental body publications and guidelines describing the development, validation, and use of structure and process indicators in perioperative care. Results: We identified 43 860 journal articles and 43 relevant indicator program publications. From these, we identified a total of 1282 clinical indicators, split into structure (36%, n=463) and process indicators (64%, n=819). The dimensions of quality most frequently addressed were effectiveness (38%, n=475) and patient safety (29%, n=363). The majority of indicators (53%, n=675) did not have a level of evidence ascribed in their literature. Patient-centred metrics accounted for the fewest published clinical indicators. Conclusions: Despite widespread use, the majority of clinical indicators are not based on a strong level of scientific evidence. There may be scope in setting standards for the development and validation process of clinical indicators. Most indicators focus on the effectiveness, safety, and efficiency of care. PROSPERO database: CRD4201501277.

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More information

Accepted/In Press date: 2 October 2017
e-pub ahead of print date: 13 December 2017
Published date: 1 January 2018
Keywords: healthcare, perioperative period, quality indicators, review, systematic

Identifiers

Local EPrints ID: 421442
URI: http://eprints.soton.ac.uk/id/eprint/421442
ISSN: 0007-0912
PURE UUID: 7eb79d8e-22bd-4b0a-80c5-b1271e98dc1c
ORCID for M.P.W. Grocott: ORCID iD orcid.org/0000-0002-9484-7581

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Date deposited: 12 Jun 2018 16:30
Last modified: 18 Mar 2024 03:12

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Contributors

Author: M. Chazapis
Author: D. Gilhooly
Author: A.F. Smith
Author: P.S. Myles
Author: G. Haller
Author: M.P.W. Grocott ORCID iD
Author: S.R. Moonesinghe

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