Lessons Learned from Anesthesia Registries About Surgical Safety and Reliability



Anesthesiology has a reputation for data-driven quality improvement. There are multiple registries focused on anesthesia, including the National Anesthesia Clinical Outcomes Registry, which have generated dozens of academic papers. Most are also used for quality improvement and pay-for-performance purposes. The future of registry development in perioperative care will focus on patient-centered outcomes, automated data capture from electronic health care records, and joint development with other specialties to meet the goal of shared accountability for patient outcomes.


Registry Quality Anesthesiology Performance improvement Big data National Anesthesia Clinical Outcomes Registry Multicenter Perioperative Outcomes Group Anesthesia Incident Reporting System Pay for performance Qualified Clinical Data Registry 


  1. 1.
    Pronovost PJ, Cleeman JI, Wright D, Srinivasan A. Fifteen years after To Err is Human: a success story to learn from. BMJ Qual Saf. 2016;25(6):396–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Koltov MK, Damle NS. Health policy basics: physician quality reporting system. Ann Intern Med. 2014;161:365–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Speir AM, Yohe C, Rich JB, Mayer JE, STS workforce on health policy, advocacy, and reform. SGR repeal: reprieve or pyrrhic victory? Ann Thorac Surg. 2015;100:1143–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Phelps G, Barach P. Why the safety and quality movement has been slow to improve care? Int J Clin Pract. 2014;68(8):932–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Barach P, Lipshultz S. The benefits and hazards of publicly reported quality outcomes. Prog Pediatr Cardiol. 2016:45–9. doi:10.1016/j.ppedcard.2016.06.001.Google Scholar
  6. 6.
    Popovich MI, Merrick S. PQRS, payment and the 2015 physician fee schedule. ASA Newsl. 2015;79:32–3.Google Scholar
  7. 7.
    Zeitlin GL. History of anesthesia records. ASA Newsl. 2013;77:26–9.Google Scholar
  8. 8.
    Rovenstine EA. A method of combining anesthetic and surgical records for statistical purposes. Anesth Analg. 1934;13:122–8.CrossRefGoogle Scholar
  9. 9.
    Beecher HK, Todd DP. A study of the deaths associated with anesthesia and surgery: based on a study of 599, 548 anesthesias in ten institutions 1948-1952, inclusive. Ann Surg. 1954;140:2–35.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Hendrickx JF, De Wolf A, Skinner S. Journal of Clinical Monitoring and Computing 2015 end of year summary: anesthesia. J Clin Monit Comput. 2015;30:1–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Cheney FW, Posner KL, Lee LA, Caplan RA, Domino KB. Trends in anesthesia-related death and brain damage: a closed claims analysis. Anesthesiology. 2006;105:1081–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Caplan RA, Posner KL, Ward RJ, Cheney FW. Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology. 1990;72(5):828–33.CrossRefPubMedGoogle Scholar
  13. 13.
    Domino KB, Posner KL, Caplan RA, Cheney FW. Awareness during anesthesia: a closed claims analysis. Anesthesiology. 1999;90(4):1053–61.CrossRefPubMedGoogle Scholar
  14. 14.
    Pollak KA, Stephens LS, Posner KL, Rathmell JP, Fitzgibbon DR, Dutton RP, Michna E, Domino KB. Trends in pain medicine liability. Anesthesiology. 2015;123(5):1133–41.CrossRefPubMedGoogle Scholar
  15. 15.
    Dutton RP, Lee LA, Stephens LS, Posner KL, Davies JM, Domino KB. Massive hemorrhage: a report from the anesthesia closed claims project. Anesthesiology. 2014;121(3):450–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Dutton RP. Registries of the anesthesia quality institute. Int Anesthesiol Clin. 2014;52:1–14.CrossRefPubMedGoogle Scholar
  17. 17.
    Kurth CD, Tyler D, Heitmiller E, Tosone SR, Martin L, Deshpande JK. National pediatric anesthesia safety quality improvement program in the United States. Anesth Analg. 2014;119(1):112–21.CrossRefPubMedGoogle Scholar
  18. 18.
    Tjia I, Rampersad S, Varughese A, Heitmiller E, Tyler DC, Lee AC, Hastings LA, Uejima T. Wake Up Safe and root cause analysis: quality improvement in pediatric anesthesia. Anesth Analg. 2014;119:122–36.CrossRefPubMedGoogle Scholar
  19. 19.
    Walker BJ, Long JB, De Oliveira GS, Szmuk P, Setiawan C, Polaner DM, Suresh S, PRAN Investigators. Peripheral nerve catheters in children: an analysis of safety and practice patterns from the pediatric regional anesthesia network (PRAN). Br J Anaesth. 2015;115:457–62.CrossRefPubMedGoogle Scholar
  20. 20.
    Walker BJ, Long JB, De Oliveira GS, Szmuk P, Setiawan C, Polaner DM, Suresh S, PRAN Investigators. Peripheral nerve catheters in children: an analysis of safety and practice patterns from the pediatric regional anesthesia network (PRAN). Br J Anaesth. 2015;115(3):457–62.CrossRefPubMedGoogle Scholar
  21. 21.
    Kheterpal S, Healy D, Aziz MF, Shanks AM, Freundlich RE, Linton F, Martin LD, Linton J, Epps JL, Fernandez-Bustamante A, Jameson LC, Tremper T, Tremper KK, Multicenter Perioperative Outcomes Group (MPOG) Perioperative Clinical Research Committee. Incidence, predictors, and outcome of difficult mask ventilation combined with difficult laryngoscopy: a report from the multicenter perioperative outcomes group. Anesthesiology. 2013;119:1360–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Liau A, Havidich JE, Onega T, Dutton RP. The National Anesthesia Clinical Outcomes Registry. Anesth Analg. 2015;121:1604–10.CrossRefPubMedGoogle Scholar
  23. 23.
    Barach P, Small DS. Reporting and preventing medical mishaps: lessons from non-medical near miss reporting systems. Br Med J. 2000;320:753–63.Google Scholar
  24. 24.
    Barach P. The impact of the patient safety movement on clinical care. Adv Anesth. 2003;21:51–80.Google Scholar
  25. 25.
    Gálvez JA, Rothman BS, Doyle CA, Morgan S, Simpao AF, Rehman MA. A narrative review of meaningful use and anesthesia information management systems. Anesth Analg. 2015;121:693–706.CrossRefPubMedGoogle Scholar
  26. 26.
    D’Agostino RS, Jacobs JP, Badhwar V, Paone G, Rankin JS, Han JM, McDonald D, Shahian DM. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2016 update on outcomes and quality. Ann Thorac Surg. 2016;101:24–32.CrossRefPubMedGoogle Scholar
  27. 27.
    Epelboym I, Gawlas I, Lee JA, Schrope B, Chabot JA, Allendorf JD. Limitations of ACS-NSQIP in reporting complications for patients undergoing pancreatectomy: underscoring the need for a pancreas-specific module. World J Surg. 2014;38:1461–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Bauer CR, Ganslandt T, Baum B, Christoph J, Engel I, Löbe M, Mate S, Stäubert S, Drepper J, Prokosch HU, Winter A, Sax U. Integrated Data Repository Toolkit (IDRT). A suite of programs to facilitate health analytics on heterogeneous medical data. Methods Inf Med. 2016;55:125–35.CrossRefPubMedGoogle Scholar
  29. 29.
    Hurrell MJ, Monk TG, Nicol A, Norton AN, Reich DL, Walsh JL. Implementation of a standards-based anaesthesia record compliant with the health level 7 (HL7) clinical document architecture (CDA). J Clin Monit Comput. 2012;26:295–304.CrossRefPubMedGoogle Scholar
  30. 30.
  31. 31.
    Sanchez J, Barach P. High reliability organizations and surgical microsystems: re-engineering surgical care. Surg Clin North Am. 2012;92:1–14.Google Scholar
  32. 32.
    Entin E, Lei F, Barach P. Teamwork skills training for patient safety in the peri-operative environment: a research agenda. Surg Innov. 2006;3:3–13.Google Scholar
  33. 33.
    Dobie KH, Tiwari V, Sandberg WS. “What have we done for us lately?”—defining performance and value at the individual clinician level. Anesthesiol Clin. 2015;33:659–77.CrossRefPubMedGoogle Scholar
  34. 34.
    Jacobs JP, Jacobs ML, Mavroudis C, et al. What is operative morbidity? Defining complications in a surgical registry database: a report of the STS congenital database taskforce and the joint EACTS-STS congenital database committee. Ann Thorac Surg. 2007;84:1416–21.CrossRefGoogle Scholar
  35. 35.
    Lilford R, Chilton PJ, Hemming K, Brown C, Girling A, Barach P. Evaluating policy and service interventions: framework to guide selection and interpretation of study end points. BMJ. 2010;341:c4413.CrossRefPubMedGoogle Scholar
  36. 36.
    Selby JV, Forsythe L, Sox HC. Stakeholder-driven comparative effectiveness research: an update from PCORI. JAMA. 2015;314:2235–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Schmocker RK, Cherney Stafford LM, Siy AB, Leverson GE, Winslow ER. Understanding the determinants of patient satisfaction with surgical care using the Consumer Assessment of Healthcare Providers and Systems surgical care survey (S-CAHPS). Surgery. 2015;158:1724–33.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Lehmann M, Monte K, Barach P, Kindler C. Postoperative patient complaints as a maker for patient safety. J Clin Anesth. 2010;22(1):13–21.Google Scholar
  39. 39.
    Desebbe O, Lanz T, Kain Z, Cannesson M. The perioperative surgical home: an innovative, patient-centred and cost-effective perioperative care model. Anaesth Crit Care Pain Med. 2016;35:59–66.CrossRefPubMedGoogle Scholar
  40. 40.
    Gelberg J, Strömsöe A, Hollenberg J, Radell P, Claesson A, Svensson L, Herlitz J. Improving survival and neurologic function for younger age groups after out-of-hospital cardiac arrest in Sweden: a 20-year comparison. Pediatr Crit Care Med. 2015;16:750–7.CrossRefPubMedGoogle Scholar
  41. 41.
    Kuroiwal M, Seo N, Furuya H, Irita K, Sawa T, Ito M, Nakamura M. Clinical characteristics of perioperative pulmonary thromboembolism in Japan—results of the perioperative thromboembolism research in the Japanese Society of Anesthesiologists. Masui. 2006;55(3):365–72.PubMedGoogle Scholar
  42. 42.
    Reed S, Arnal D, Frank O, Gomez-Arnau JI, Hansen J, Lester O, Mikkelsen KL, Rhaiem T, Rosenberg PH, St Pierre M, Schleppers A, Staender S, Smith AF. National critical incident reporting systems relevant to anaesthesia: a European survey. Br J Anaesth. 2014;112:546–55.CrossRefPubMedGoogle Scholar
  43. 43.
    Cook TM, Woodall N, Frerk C, Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106:617–31.CrossRefPubMedGoogle Scholar
  44. 44.
    Barach P, Pahl R, Butcher A. Actions and not words. Randwick, NSW: JBara Innovations for HQIP, National Health Service, London; 2013.Google Scholar
  45. 45.
    Cook TM, Andrade J, Bogod DG, Hitchman JM, Jonker WR, Lucas N, Mackay JH, Nimmo AF, O’Connor K, O’Sullivan EP, Paul RG, Palmer JH, Plaat F, Radcliffe JJ, Sury MR, Torevell HE, Wang M, Hainsworth J, Pandit JJ, Royal College of Anaesthetists; Association of Anaesthetists of Great Britain and Ireland. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent, and medicolegal issues. Br J Anaesth. 2014;113:560–74.CrossRefPubMedGoogle Scholar
  46. 46.
    Runciman WB, Webb RK, Lee R, Holland R. The Australian Incident Monitoring Study. System failure: an analysis of 2000 incident reports. Anaesth Intensive Care. 1993;21(5):684–95.PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.US Anesthesia PartnersDallasUSA

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