Improving compliance with hospital accreditation standards for anesthesia through repetitive feedback and education a cross- sectional study

Background : Compliance with quality and patient safety guidelines for anesthesia is important but difficult to obtain. Many hospitals worldwide are preparing for or passing an accreditation process with Joint Commission International (JCI), with anesthesia teams endeavoring optimal conformity with these JCI guidelines. Requirements involve pre-anesthesia assessment, informed consent, pre-induction assessment, a safe surgery checklist, anesthesia record keeping and correct postoperative care. Objectives : Our primary goal was to improve quality of anesthesia care and patient safety through optimization of perioperative flow and anesthesia file documentation, by addressing issues with the implementation of key anesthesia requirements, the required steps to achieve optimal compliance and the need for sustained efforts to maintain quality standards or continue improvement. Our secondary goal was to consolidate progress and to prevent a decrease in compliance, by continuing to measure compliance and by giving feedback up to 2 years later. Methods : Postoperatively, all records of patients undergoing general or regional anesthesia were assessed on completeness. Compliance was measured at baseline, during the 4 months before and after the JCI-audit, and at 1 year (1y) and 2y follow up study periods. Process improvements were done in all study periods, except when preparing the 1y follow up study period. Statistical analysis was performed using the Cochran-Armitage trend test, Chi Square, Fischer Exact and ANOVA tests. Results with p < 0.05 were considered statistically significant. Results : Significant improvement in compliance was observed in pre-anesthesia assessment, informed consent, pre-induction assessment, and anesthesia record keeping. One year later, however, improvement was not sustained for pre-anesthesia assessment and informed consent. New interventions preparing the two year follow up study period significantly improved compliance with these requirements. Conclusion : This study shows the strong potential for improving compliance with JCI Standards for Anesthesia, through streamlining procedures, intensive communication and accurate follow-up. The damping effect late after stopping the communications shows that it is important to persevere much longer than previously thought