Quality has been defined by six domains: effective, equitable, timely, efficient, safe, and patient centered. Quality of anesthesia care can be improved through measurement, either through local measures in quality improvement or through national measures in value-based purchasing programs. Death directly related to anesthesia care has been reduced, but must be measured beyond simple mortality. To improve perioperative care for our patients, we must take shared accountability for all surgical outcomes including complications, which has traditionally been viewed as being surgically related. Anesthesiologists can also impact public health by being engaged in improving cognitive recovery after surgery and addressing the opiate crisis. Going forward, we must focus on what patients want and deserve: improved patient-oriented outcomes and satisfaction with our care. By listening to our patients and being engaged in the entire perioperative process, we can make the greatest impact on perioperative care.
Improvements in surgical morbidity and mortality occur when measurement and feedback is provided. The Veterans Administration National Surgical Quality Improvement Program was commissioned because of concerns regarding increased mortality associated with surgical care at the Veterans Administration Hospitals. With implementation of National Surgical Quality Improvement Program outcome-based assessment and report card back to the hospitals, there was a marked improvement in both mortality and complication rates during the implementation phase.14 During a period of increasing transparency of perioperative outcomes in nonfederal hospitals, Finks et al.15 used Medicare data to demonstrate reductions in surgical mortality over a 10-yr period in major abdominal and thoracic procedures. Despite the improvement in the public and private sectors, 30-day mortality remained high in this group of high-risk surgeries, which suggests room for improvement, as opposed to the ambulatory surgery population where rates of complications are much lower. Because complications are a function of the interaction of patient factors, system factors, and clinical skills, it will require attention to all three domains to achieve optimal patient outcomes. If all groups assume joint ownership, including patients, hospitals, and providers, then outcomes will be improved.