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Quality of Care: Maintaining Safety Through Minimum Standards

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The Role of Anesthesiology in Global Health

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Abstract

One of the greatest challenges to effective surgical and perioperative care in low and middle resource settings is creating conditions that meet surgical and anesthetic standards of patient safety and quality care. In limited resource settings, minimum standards of quality must be achieved to perform safe humanitarian surgery. This requires assessment of the location where care will be provided and maintenance of the three pillars of quality care: structural inputs, the process of care, and outcome measures. Preparation and advancement in quality is a low cost, high yield way to improve patient safety, decrease surgical complications, and improve global surgery outcomes, and these techniques should be applied in the setting of short term surgical trips and encouraged in local health care systems.

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References

  1. Chu KM, Trelles M, Ford NP. Quality of care in humanitarian surgery. World J Surg. 2011;35(6):1169–72. discussion 1173–1164.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Bickler S, Ozgediz D, Gosselin R, et al. Key concepts for estimating the burden of surgical conditions and the unmet need for surgical care. World J Surg. 2010;34(3):374–80.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Birkmeyer JD, Dimick JB, Birkmeyer NJ. Measuring the quality of surgical care: structure, process, or outcomes? J Am Coll Surg. 2004;198(4):626–32.

    Article  PubMed  Google Scholar 

  4. The Joint Commission. http://www.jointcommission.org. Accessed 1 May 2014.

  5. Chassin MR, Loeb JM, Schmaltz SP, Wachter RM. Accountability measures—using measurement to promote quality improvement. N Engl J Med. 2010;363(7):683–8.

    Article  CAS  PubMed  Google Scholar 

  6. Hall BL, Hamilton BH, Richards K, Bilimoria KY, Cohen ME, Ko CY. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg. 2009;250(3):363–76.

    PubMed  Google Scholar 

  7. Khuri SF. The NSQIP: a new frontier in surgery. Surgery. 2005;138(5):837–43.

    Article  PubMed  Google Scholar 

  8. Khuri SF, Daley J, Henderson W, et al. The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg. 1998;228(4):491–507.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Khuri SF, Henderson WG, Daley J, et al. Successful implementation of the Department of Veterans Affairs’ National Surgical Quality Improvement Program in the private sector: the Patient Safety in Surgery study. Ann Surg. 2008;248(2):329–36.

    Article  PubMed  Google Scholar 

  10. Anesthesia Quality Institute. https://www.aqihq.org/index.aspx. Accessed 1 May 2014.

  11. Physician Quality Reporting System. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/pqrs/index.html. Accessed 1 May 2014.

  12. Schlack WS, Boermeester MA. Patient safety during anaesthesia: incorporation of the WHO safe surgery guidelines into clinical practice. Curr Opin Anaesthesiol. 2010;23(6):754–8.

    Article  PubMed  Google Scholar 

  13. McConkey SJ. Case series of acute abdominal surgery in rural Sierra Leone. World J Surg. 2002;26(4):509–13.

    Article  PubMed  Google Scholar 

  14. Bickler SW, Sanno-Duanda B. Epidemiology of paediatric surgical admissions to a government referral hospital in the Gambia. Bull World Health Organ. 2000;78(11):1330–6.

    PubMed Central  CAS  PubMed  Google Scholar 

  15. Ouro-Bang’na Maman AF, Tomta K, Ahouangbevi S, Chobli M. Deaths associated with anaesthesia in Togo, West Africa. Trop Doct. 2005;35(4):220–2.

    Article  PubMed  Google Scholar 

  16. Hansen D, Gausi SC, Merikebu M. Anaesthesia in Malawi: complications and deaths. Trop Doct. 2000;30(3):146–9.

    CAS  PubMed  Google Scholar 

  17. McKenzie AG. Mortality associated with anaesthesia at Zimbabwean teaching hospitals. S Afr Med J. 1996;86(4):338–42.

    CAS  PubMed  Google Scholar 

  18. WHO guidelines for safe surgery 2009: safe surgery saves lives. Geneva; 2009.

    Google Scholar 

  19. Safe Surgery Saves Lives. http://www.who.int/patientsafety/safesurgery/en/. Accessed 10 May 2014.

  20. Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. http://www.who.int/surgery/publications/QuickSitAnalysisEESCsurvey.pdf. Accessed 7 May 2014.

  21. Chu K, Stokes C, Trelles M, Ford N. Improving effective surgical delivery in humanitarian disasters: lessons from Haiti. PLoS Med. 2011;8(4):e1001025.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Unnecessary Amputations Performed in Haiti? http://limblossinformationcentre.com/2010/02/05/unnecessary-amputations-performed-in-haiti/. Accessed 7 May 2014.

  23. Merry AF, Cooper JB, Soyannwo O, Wilson IH, Eichhorn JH. International Standards for a Safe Practice of Anesthesia 2010. Can J Anaesth. 2010;57(11):1027–34.

    Article  PubMed Central  PubMed  Google Scholar 

  24. International Activity Report 2010-Haiti. http://www.msf.org/international-activity-report-2010-haiti. Accessed 7 May 2014.

  25. Venticinque SG, Grathwohl KW. Critical care in the austere environment: providing exceptional care in unusual places. Crit Care Med. 2008;36(7 Suppl):S284–92.

    Article  PubMed  Google Scholar 

  26. The Universal Anesthesia Machine. http://www.gradianhealth.org/universal-anaesthesia-machine/. Accessed 16 May 2014.

  27. Hand Hygeine in Healthcare Settings. http://www.cdc.gov/handhygiene/Basics.html. Accessed 12 May 2014.

  28. UNICEF WASH strategies. http://www.unicef.org/wash/index_43084.html. Accessed 17 May 2014.

  29. The Sphere Project. http://www.spherehandbook.org/en/appendix-2/. Accessed 27 May 2014.

  30. McQueen KA, Parmar P, Kene M, et al. Burden of surgical disease: strategies to manage an existing public health emergency. Prehosp Disaster Med. 2009;24 Suppl 2:s228–31.

    PubMed  Google Scholar 

  31. Water and Sanitation. http://www.msf.org/topics/water-and-sanitation. Accessed 17 May 2014.

  32. Basavaraju SV, Mwangi J, Nyamongo J, et al. Reduced risk of transfusion-transmitted HIV in Kenya through centrally co-ordinated blood centres, stringent donor selection and effective p24 antigen-HIV antibody screening. Vox Sang. 2010;99(3):212–9.

    Article  CAS  PubMed  Google Scholar 

  33. Blood safety and availability. http://www.who.int/mediacentre/factsheets/fs279/en/. Accessed 17 May 2014.

  34. The blood cold chain. http://www.who.int/mediacentre/factsheets/fs279/en/. Accessed 17 May 2014.

  35. Erhabor O, Adias TC, Mainasara A. Provision of safe blood transfusion services in a low income setting in West Africa. Case study of Nigeria. In: Berhardt L, editor. Advances in medicine and biology, vol. 59. New York, USA: Nova Science Publishers; 2013. p. 1–58.

    Google Scholar 

  36. Mellor AJ. Anaesthesia in austere environments. J R Army Med Corps. 2005;151(4):272–6.

    Article  CAS  PubMed  Google Scholar 

  37. Morey TE, Rice MJ. Anesthesia in an austere setting: lessons learned from the Haiti relief operation. Anesthesiol Clin. 2013;31(1):107–15.

    Article  PubMed  Google Scholar 

  38. WHO model lists of essential medicines. http://www.who.int/medicines/publications/essentialmedicines/en/. Accessed 19 May 2014.

  39. Walker IA, Newton M, Bosenberg AT. Improving surgical safety globally: pulse oximetry and the WHO Guidelines for Safe Surgery. Paediatr Anaesth. 2011;21(7):825–8.

    Article  CAS  PubMed  Google Scholar 

  40. WHO patient safety pulse oximetry project. http://www.who.int/patientsafety/safesurgery/pulse_oximetry/en/. Accessed 10 May 2014.

  41. Lifebox. http://www.lifebox.org. Accessed 10 May 2014.

  42. Chackungal S, Nickerson JW, Knowlton LM, et al. Best practice guidelines on surgical response in disasters and humanitarian emergencies: report of the 2011 Humanitarian Action Summit Working Group on Surgical Issues within the Humanitarian Space. Prehosp Disaster Med. 2011;26(6):429–37.

    Article  PubMed  Google Scholar 

  43. Inipavudu B, Mitterschiffthaler G, Hasibeder WR, Dunser MW. Spinal versus epidural anesthesia for vesicovaginal fistula repair surgery in a rural sub-Saharan African setting. J Clin Anesth. 2007;19(6):444–7.

    Article  PubMed  Google Scholar 

  44. Surgical care at the district hospital. http://www.who.int/surgery/publications/en/SCDH.pdf?ua=1. Accessed 27 May 2014.

  45. Allcock E, Spencer E, Frazer R, Applegate G, Buckenmaier 3rd C. Continuous transversus abdominis plane (TAP) block catheters in a combat surgical environment. Pain Med. 2010;11(9):1426–9.

    Article  PubMed  Google Scholar 

  46. Buckenmaier 3rd CC, Lee EH, Shields CH, Sampson JB, Chiles JH. Regional anesthesia in austere environments. Reg Anesth Pain Med. 2003;28(4):321–7.

    PubMed  Google Scholar 

  47. Ozgediz D, Hsia R, Weiser T, et al. Population health metrics for surgery: effective coverage of surgical services in low-income and middle-income countries. World J Surg. 2009;33(1):1–5.

    Article  PubMed  Google Scholar 

  48. Gilbert BJ, Miller C, Corrick F, Watson RA. Should trainee doctors use the developing world to gain clinical experience? The annual Varsity Medical Debate—London, Friday 20th January, 2012. Philos Ethics Humanit Med. 2013;8:1.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Ramsey KM, Weijer C. Ethics of surgical training in developing countries. World J Surg. 2007;31(11):2067–9. discussion 2070-2061.

    Article  PubMed  Google Scholar 

  50. Bilimoria KY, Phillips JD, Rock CE, Hayman A, Prystowsky JB, Bentrem DJ. Effect of surgeon training, specialization, and experience on outcomes for cancer surgery: a systematic review of the literature. Ann Surg Oncol. 2009;16(7):1799–808.

    Article  PubMed  Google Scholar 

  51. Dimick JB, Birkmeyer JD, Upchurch Jr GR. Measuring surgical quality: what’s the role of provider volume? World J Surg. 2005;29(10):1217–21.

    Article  PubMed  Google Scholar 

  52. Rogo-Gupta LJ, Lewin SN, Kim JH, et al. The effect of surgeon volume on outcomes and resource use for vaginal hysterectomy. Obstet Gynecol. 2010;116(6):1341–7.

    Article  PubMed  Google Scholar 

  53. Wilt TJ, Shamliyan TA, Taylor BC, MacDonald R, Kane RL. Association between hospital and surgeon radical prostatectomy volume and patient outcomes: a systematic review. J Urol. 2008;180(3):820–8. discussion 828-829.

    Article  PubMed  Google Scholar 

  54. Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Am J Surg. 2005;189(4):395–404.

    Article  PubMed  Google Scholar 

  55. Smaill F, Hofmeyr GJ. Antibiotic prophylaxis for cesarean section. Cochrane Database Syst Rev. 2002(3):CD000933.

    Google Scholar 

  56. Weiser TG, Haynes AB, Lashoher A, et al. Perspectives in quality: designing the WHO Surgical Safety Checklist. Int J Qual Health Care. 2010;22(5):365–70.

    Article  PubMed  Google Scholar 

  57. de Vries EN, Prins HA, Crolla RM, et al. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med. 2010;363(20):1928–37.

    Article  PubMed  Google Scholar 

  58. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491–9.

    Article  CAS  PubMed  Google Scholar 

  59. Ginzburg E, O’Neill WW, Goldschmidt-Clermont PJ, Marchena E, Pust D, Green BA. Rapid medical relief—Project Medishare and the Haitian earthquake. N Engl J Med. 2010;362(10):e31.

    Article  CAS  PubMed  Google Scholar 

  60. MacIntyre NR, Jeffcoat DM, Chan DB, Lorich DG, Helfet DL. The experiences of a surgical response team in Haiti. Am J Orthop (Belle Mead NJ). 2010;39(4):172–201.

    Google Scholar 

  61. Merin O, Ash N, Levy G, Schwaber MJ, Kreiss Y. The Israeli field hospital in Haiti—ethical dilemmas in early disaster response. N Engl J Med. 2010;362(11):e38.

    Article  CAS  PubMed  Google Scholar 

  62. Peranteau WH, Havens JM, Harrington S, Gates JD. Re-establishing surgical care at Port-au-Prince General Hospital, Haiti. J Am Coll Surg. 2010;211(1):126–30.

    Article  PubMed  Google Scholar 

  63. Bermudez L, Carter V, Magee Jr W, Sherman R, Ayala R. Surgical outcomes auditing systems in humanitarian organizations. World J Surg. 2010;34(3):403–10.

    Article  PubMed  Google Scholar 

  64. Chu KM, Ford N, Trelles M. Operative mortality in resource-limited settings: the experience of Medecins Sans Frontieres in 13 countries. Arch Surg. 2010;145(8):721–5.

    Article  PubMed  Google Scholar 

  65. ClinicalTrials.gov. http://clinicaltrials.gov. Accessed 11 May 2014.

  66. ACS Case Log System. http://www.efacs.org. Accessed 11 May 2014.

  67. Wall AE. Ethics in global surgery. World J Surg. 2014;38(7):1574–80.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Eerste River Hospital, Eerste River, South Africa

    Kathryn Chu M.D., M.P.H.

  2. Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA

    Monique James M.D., M.P.H.

Authors
  1. Kathryn Chu M.D., M.P.H.
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  2. Monique James M.D., M.P.H.
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Corresponding author

Correspondence to Kathryn Chu M.D., M.P.H. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA

    Ram Roth

  2. Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA

    Elizabeth A.M. Frost

  3. Department of Anesthesiology, LSU Health Sciences Center, New Orleans, Louisiana, USA

    Clifford Gevirtz

  4. Department of Anesthesiology, Oregon Anesthesiology Group, Adventist Medical Center, Portland, Oregon, USA

    Carrie L.H. Atcheson

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Chu, K., James, M. (2015). Quality of Care: Maintaining Safety Through Minimum Standards. In: Roth, R., Frost, E., Gevirtz, C., Atcheson, C. (eds) The Role of Anesthesiology in Global Health. Springer, Cham. https://doi.org/10.1007/978-3-319-09423-6_10

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  • DOI: https://doi.org/10.1007/978-3-319-09423-6_10

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