Spectrum Medical Group's anesthesiologist Craig Curry,. M.D., explains how FIDES - a quality database - can improve quality and reduce patient side effects.

1. Using a Database in Private Practice to Improve Care

6. 2009 MMC Quality Reports PACU Nausea: Jan 99 – Dec 09

7. 2009 MMC Quality Reports PACU Vomiting: Jan 99 – Dec 09

8. 2009 MMC Quality Reports Post-discharge Vomiting: Jan 99 – Dec 09

9. Long Term PACU High Risk Temp Trends Mean Temp on Arrival: Jan 99 – Dec 09

10. Long Term PACU High Risk Temp Trends % < 36  C Jan 99 – Sep 10

11. Case Specific Trends

13. Control Chart Analysis Anesthesiology

14. Trend Analysis Event 2003 2004 2005 2006 2007 2008 2009 2010 Incomplete 1799 1850 2721 2252 2422 1945 1914 2013 No Untoward Events 10030 16993 16990 17557 17885 18054 19429 18108 Near miss/safety concern 12 7 2 7 3 12 12 15 Aspiration 27 42 66 51 43 47 26 15 Unable to intubate 3 5 2 5 4 3 4 1 Difficulty with intubation 26 61 68 48 63 68 81 47 Dental injury 9 9 13 15 8 13 16 2 Wet tap 4 11 2 3 0 3 1 2 Unplanned admit to SCU 7 15 8 12 12 19 19 0 Failed regional block 13 24 26 17 16 11 13 20 Equipment malfunction 6 17 15 13 21 53 90 81 Medication event 12 14 15 9 5 10 13 13 Vascular access complication 2 6 6 4 2 5 16 17 Case cancelled 1 6 6 4 9 7 13 16 MI/Ischemia requiring Rx/Cancellation 1 7 4 4 15 4 10 15 Cardiac arrest 5 12 6 7 8 9 10 10 Death 11 15 13 11 17 11 10 5 Blue button 6 22 18 13 16 21 19 23 Other 40 60 57 55 49 68 80 189 Hypoxemia/desaturation <90% for >3 min 33 62 64 12 21 26 23 37 Pneumothorax 3 4 1 2 Returned Slips: 12018 19237 20100 20120 20600 20356 21785 20668

15. Event 2003 2004 2005 2006 2007 2008 2009 2010 Incomplete 7826 11691 12302 8579 9115 9861 10363 14395 No untoward events 2184 4137 4909 8441 9137 8115 9473 4320 Airway obstruction requiring support 15 20 23 32 23 14 27 23 Reintubation 16 7 12 17 13 11 16 8 Unplanned mechanical ventilation 24 21 16 28 28 13 28 13 Agitation requiring restraint or drug Rx 19 32 27 27 14 18 13 21 Angina diagnosed by physician 5 10 11 7 2 6 6 0 Arrhythmia requiring physician input 36 49 56 96 69 80 53 46 Hypertension requiring physician input 41 54 53 87 68 93 54 67 Hypotension requiring physician input 79 118 116 144 124 101 107 96 Cardiac arrest 1 0 1 2 5 2 2 1 Blue button 1 1 1 3 4 3 3 5 Death 0 0 0 1 2 1 0 1 Flumazenil given 0 1 6 0 1 1 0 3 Narcan given 3 7 4 9 8 7 6 5 Muscle relaxant given 1 2 5 3 3 3 1 0 Reversal given 0 4 5 10 4 3 7 4 Hypothermia 76 188 68 61 45 46 56 23 Excessive pain 304 440 431 445 270 185 161 164 Prolonged N/V 39 68 38 68 40 28 29 18 Complicated patient hx not communicated 4 6 6 10 7 8 10 5 Delayed voiding requiring physician input 15 35 37 48 42 38 52 18 Eye injury requiring physician input 1 9 13 25 48 54 62 77 Bleeding requiring physician input 13 29 36 33 18 18 15 16 Unintended intraop awareness 0 0 0 6 3 1 2 1 Other - PACU event 114 273 269 312 221 184 196 186 Unplanned PACU admit/23 hr 7 8 10 29 24 24 13 4 Planned PACU admit/23 hr 55 74 72 8 8 7 2 0 Returned Slips: 12018 19237 20100 20120 20600 20114 21785 20668

16. Intraop Event Qualitative Series Reviewers Event Reviewer Dr. Gagnon Dr. Curry Dr. Makrides Dr. Dougherty Dr. Dougherty Dr. Gleason Dr. Siegle Dr. Curry Dr. Dougherty Dr. Siegle Dr. Boulanger Dr. Ascanio

22. Project: Infection Control - Epidural Displacements Free chlorhexidine prep introduced Convert to Paper Frame Taping

23. Rocuronium Introduced Provider Education and Rocuronium Removed

24. Using References Literature An analysis of reintubations from a quality assurance database of 152,000 cases . J Clin Anesth. 2003 Dec;15(8):575-81. Lee PJ, MacLennan A, Naughton NN, O'Reilly M. Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI 48109-0048, USA. DESIGN: Retrospective study. SETTING: University of Michigan Department of Anesthesiology Quality Assurance (QA) database. RESULTS: A total of 191 reintubation events were identified (0.11%). AQI, ABG, SAMBA or other specialty reference

26. Self Reflection

30. Using QA Data &quot;Not everything that can be counted counts, and not everything that counts can be counted&quot;. Albert Einstein

33. Compliance with Quality Program Individual Physicians

36. MOCA

37. Using QA Data