Table 2 List of anaesthesia quality indicators ranked by response in the fourth round of the mDelphi. The % column is the percent of respondents who ranked the indicator in the top 20. Similar items are grouped together though deemed sufficiently different to list separately. An asterisk marks the items deemed most easily extractable from and EMR/AIMS

Airway complications (greater than 3 attempts at intubation, cannot intubate/cannot ventilate, laryngospasm, hypoxia, dental/soft tissue injury)∗

93

Process &

Outcome

Incidence & duration of perioperative adverse events including hypoxia, hyper/hypocarbia, hyper/hypothermia, hyper/hypoglycemia, anesthetic overdose∗

Degree & duration of hypotension on induction (SBP < 80) ∗

86

71

Outcome

Outcome

Number of medical errors (patient receiving wrong drug, drug dose, wrong surgical site, wrong blood product etc)

Medication error with wrong medication or wrong dose given

Number of wrong site or side procedures

79

71

< 1

Process

Process

Process/Structure?

Patient satisfaction (composite patient experience)

79

Outcome

Postoperative residual neuromuscular blockade (ToF < 0.9 measured 15 min after arrival to PACU, clinical residual weakness) requiring intervention by an anesthesiologist to treat inadequate reversal of neuromuscular blockade∗

71

Outcome

Temperature less than 35.5 Celsius on arrival to PACU∗

71

Outcome

Complications of neuraxial block (failed block, inadvertent dural puncture, high block, infection, neurologic complication etc) ∗

Inadequate regional/neuraxial block requiring supplemental analgesia, sedation or conversion to GA required for surgery∗

Epidural or neuraxial technique not working as planned, inadequate pain coverage necessitating additional interventions

64

43

14

Outcome

Outcome/Process

Outcome

Incidence of severe postoperative nausea and vomiting (2 or more episodes of severe nausea/vomiting over 6 hours apart OR requiring more than 2 doses of antiemetics; patients who receive an intervention by an anesthesiologist for PONV not responding to PACU protocols in the recovery period) ∗

64

Outcome

Complications of central venous line placement (arterial puncture, pneumothorax, nerve injury, infection, etc) ∗

57

Outcome

Intervention required by an anesthesiologist in PACU to relieve respiratory distress∗

57

Outcome & Process

Perioperative cardiac complications (arrhythmia, ischemia, myocardial infarction) ∗

50

Outcome

Adequacy of postoperative pain management (pain scores at defined intervals, plan documentation, care pathway milestones, etc) ∗

50

Outcome

All cause complications within 30 days or until hospital discharge or death

50

Outcome

Proportion of patients receiving appropriate surgical antibiotic prophylaxis∗

50

Process & Structure

Unplanned overnight admission of day surgery patients for anesthetic reasons

50

Outcome

Pain scores on arrival to PACU∗

50

Outcome

Cerebrovascular accident developing during or within 48h of anesthetic care

43

Outcome

Monitoring hand hygiene (direct observation or mechanical monitoring)

43

Process & Structure

Adequate perioperative management of patient’s current medications

43

Process

Incidence of intraoperative awareness

43

Outcome

Incidence of delirium during the postoperative period

43

Outcome

Patient requiring an intervention by an anesthesiologist for circulatory/hemodynamic reasons in the recovery period∗

36

Outcome

Critical incident reviews for rare and infrequently occurring events

36

Process & Structure

Ultrasound used for vascular access procedures∗

36

Process

Unplanned admission to ICU or high dependency unit within 24h of a procedure involving anesthesiology

36

Outcome

Proportion of charts with documentation of informed consent and risks on anesthetic technique∗

29

Process & Structure

Patients developing severe respiratory depression requiring naloxone administration during acute pain management∗

29

Outcome & Process

Unplanned extended PACU stay for medical reasons

29

Outcome

Adherence to care pathway processes (eg. ERAS or fast track protocols)

29

Process

Percentage of cases receiving PONV prophylaxis∗

29

Process

Renal insufficiency (25% increase in serum creatinine or absolute increase > 44umol/L at any time within the first 5 postop days) or renal failure (doubling of serum creatinine or oliguria < 500ml/24h developing during or within 48h or anesthetic care)

29

Outcome

Visual loss or eye injury∗

21

Outcome

360 degree evaluation

21

Structure & Process

ASA physical status class∗

21

N/A

Time to patient orientation (able to correctly answer name and whereabouts)

21

Outcome

Surgical safety checklist completed before induction∗

14

Process & Structure

Preoperative patient anxiety adequately addressed by anesthesiologist (eg. Bauer questionnaire 24h postop)

14

Outcome & Process

Caseload breakdown by anesthetic technique (GA, neuraxial, regional, sedation, local, none, etc) ∗

14

Process

Adverse drug reaction other than anaphylaxis∗

14

Outcome

Transfusion-related complications (volume overload, TRALI, ABO incompatibility)

14

Outcome

Noncardiogenic pulmonary edema during or within 48h or anesthetic care

14

Outcome

Surgical service∗

14

N/A

Surgical priority (emergent, urgent, elective) ∗

14

N/A

Surgical caseload (time of day, day of week) ∗

14

N/A

Number of GA cases using neuromuscular blockade where reversal was given intraoperatively∗

14

Process

Epidural or neuraxial technique not working as planned, inadequate pain coverage necessitating additional interventions

14

Outcome

General anesthetic given for a Cesarean section∗

< 1

Process

Proportion of patient with clearly documented transfer of care immediately postoperatively to a PACU or ICU (eg. checklist) ∗

< 1

Process

Incidence of local anesthetic toxicity∗

0

Outcome

Number of patients receiving a blood transfusion in OR or PACU∗

0

Outcome

Number of cases where PACU was bypassed∗

0

Process & Structure