Peer comparison: a trigger for raising the standard to achievable heights

By:

Ezihe-Ejiofor, J.A

Contributor(s):

Publication details: 2015Uniform titles:

International Journal of Obstetric Anesthesia

Online resources:

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Summary: Introduction: Peer comparison is an important management tool in industry designed to evaluate performance and identify opportunities for improvement. Our maternity unit recently underwent significant expansion with over 80% increase in the number of deliveries. In this period there was a critical incident involving delayed respiration in a post -caesarean section patient. As a result long acting neuraxial opioids were withdrawn from use in caesarean sections. Methods: The aim of this service evaluation was to map the postoperative recovery profile of our parturients and compare this with another hospital in the same region with a similar number of deliveries and facing similar challenges. The first author was involved in both projects. A ll elective and emergency patients were followed up for 48 h post caesarean section. We collected data on worst pain, least pain, nausea, drowsiness scores (0 -10) and outcomes contributing to or affected by suboptimal analgesia such as time to first oral intake and time to mobilisation. Results: We included 88 patients from our hospital (OH). and 100 patients from the reference hospital (RH). Our patients had higher worst pain scores on postoperative days 1 and 2. The time to first oral intake was nearly 5 times longer than in RH. In RH 38% (18/47) elective patients were discharged on postoperative day 1 compared to 0% (0/34) of elective patients in OH. The most frequent free text comment from OH parturients was that soon after the spinal wore off, the incisional pain came with a "bang" or "full force". This was reported by women of different parity, educational levels and culture. Discussion: Good postoperative analgesia expedites the return to normality. Poorly managed post-caesarean section pain is a recognised factor for the development of chronic post surgical pain. However, there still remains little consensus within the obstetric anaesthesia community as to what the ideal number to achieve is for post -caesarean section pain scores. Despite obvious outcome differences majority of our parturients reported overall satisfaction with their experience. Our project raises the question of when patient satisfaction should be accepted as synonymous with satisfactory practice? With self-directed peer comparison we used an existing hospital as a standard and set achievable performance goals. This involves teaching TAP blocks, midwife education and a re-audit.  [Conference abstract]

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Introduction: Peer comparison is an important management tool in industry designed to evaluate performance and identify opportunities for improvement. Our maternity unit recently underwent significant expansion with over 80% increase in the number of deliveries. In this period there was a critical incident involving delayed respiration in a post -caesarean section patient. As a result long acting neuraxial opioids were withdrawn from use in caesarean sections. Methods: The aim of this service evaluation was to map the postoperative recovery profile of our parturients and compare this with another hospital in the same region with a similar number of deliveries and facing similar challenges. The first author was involved in both projects. A ll elective and emergency patients were followed up for 48 h post caesarean section. We collected data on worst pain, least pain, nausea, drowsiness scores (0 -10) and outcomes contributing to or affected by suboptimal analgesia such as time to first oral intake and time to mobilisation. Results: We included 88 patients from our hospital (OH). and 100 patients from the reference hospital (RH). Our patients had higher worst pain scores on postoperative days 1 and 2. The time to first oral intake was nearly 5 times longer than in RH. In RH 38% (18/47) elective patients were discharged on postoperative day 1 compared to 0% (0/34) of elective patients in OH. The most frequent free text comment from OH parturients was that soon after the spinal wore off, the incisional pain came with a "bang" or "full force". This was reported by women of different parity, educational levels and culture. Discussion: Good postoperative analgesia expedites the return to normality. Poorly managed post-caesarean section pain is a recognised factor for the development of chronic post surgical pain. However, there still remains little consensus within the obstetric anaesthesia community as to what the ideal number to achieve is for post -caesarean section pain scores. Despite obvious outcome differences majority of our parturients reported overall satisfaction with their experience. Our project raises the question of when patient satisfaction should be accepted as synonymous with satisfactory practice? With self-directed peer comparison we used an existing hospital as a standard and set achievable performance goals. This involves teaching TAP blocks, midwife education and a re-audit.&nbsp;&nbsp;[Conference abstract]

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