The Society for Ambulatory Anesthesia (SAMBA) Clinical Outcomes Registry (SCOR) may be a useful tool to help anesthesiologists improve the quality of their practices, preliminary data suggest.
As the drive for quality continues, anesthesiologists must decide the best way to document and demonstrate quality measures. SCOR may be a good system for starting that process, no matter which payment model is used, according to Karen Carlson, MD, MBA, assistant professor of anesthesiology at the Emory University School of Medicine, in Atlanta. For example, the merit-based incentive payment system requires information about quality, resource use, cost of care, use of technology and clinical practices.
“You must be able to explain what you’re doing and how you’re doing it,” said Dr. Carlson, chairwoman of the SCOR committee, during the 2016 joint meeting held by SAMBA and the American Society of Anesthesiologists (ASA). “Data makes a practice change and improve.”
The national registry was started in 2010 and now has more than 200,000 cases that anesthesiologists can compare their data against to draw conclusions about their patients, procedures and outcomes. The registry uses data from a form that details a patient’s activities throughout the procedure and when they go to the recovery room. The form is recorded by hand and includes details on the patient (e.g., age, ASA physical status, height, weight, comorbidities and smoking status), surgeon, anesthesiologist and procedure. The form also collects intraoperative information such as start/end time, anesthetic technique (e.g., total intravenous anesthesia or gas), antibiotics and analgesics.
Once a patient enters the PACU, the recovery nurse tracks adverse events, pain score, unplanned catheters, opioid medications, nausea and vomiting. After discharge, nurses follow up with patients to collect data about pain control, patient satisfaction, and post-discharge nausea and vomiting.
“It’s a great tool to confirm what you think your practice looks like,” Dr. Carlson said.
Dr. Carlson said anesthesiologists can easily mine the data by running several standard or custom reports. The latter allows anesthesia providers to look for the measures that matter most to them, such as nausea rate or patient satisfaction.
Ambulatory surgery centers can use these reports to identify problems and make changes to improve process results. Anesthesia practices can use the data to gauge individual and group performance, as well as compare group performance with the entire SCOR database for benchmark scores. For example, a center analyzed postoperative nausea and vomiting data to verify that patients received enough antiemetics in correlation with Apfel scores, Dr. Carlson said. In another case, a practice examined procedure times and found that adolescents generally received general anesthesia for five minutes longer than other patients.
“Of course, everybody believes they have the sickest or oldest patients in the world, but check your data,” Dr. Carlson said, while pulling up a report about ASA physical status.
“If you compare my center to the database, you’ll see that 45% are ASA [physical status] III or IV versus less than 25% of the others.”
Improving Practice Outcomes
Dr. Carlson said administrative assistants or nurse anesthetists at Emory have already adopted the data entry into their workflow. Each form takes about 60 to 90 seconds to enter into the registry, which tallies up to around 30 to 60 minutes of data per day for a caseload of 30 to 40 patients.
When Dr. Carlson became the medical director of the ambulatory surgery center at the Emory Clinic in 2012, she observed in a SCOR report that cataract surgery patients spent 17 minutes longer in the PACU than the operating room. She implemented a new criteria-based protocol that discharged patients after two blood pressure measures and two recovery scores of 9 or 10. Discharge time dropped by nine minutes but was still longer than she wanted. Then the facility stopped requiring patients to change out of their clothes for cataract surgery, which dropped the average PACU time by a few more minutes.
She also noticed that the callback rate for cataract patients was less than 40%. She implemented a new policy that required follow-up calls for all procedures—not only for general anesthesia. The callback rate increased, so she suggested that nurses should call on three different days at three different times to reach the patient. The rate jumped to 80%, but Dr. Carlson said there is still room for improvement.
“We’re still working on it,” she said. “It’s great to make a practice change and see if it really makes a difference in the data.”