PubMed · 9230590
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J S Gage. Implications of java technology.. https://pubmed.ncbi.nlm.nih.gov/9230590/
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The Stanford University Department of Anesthesia established performance standards by identifying aspects of their service that were related to an important "customer's" perception of quality. A "quality grid" targeted service attributes that surgeons scored high for importance and low for performance. Control charts and flow charts helped establish reasonable performance levels for "timely first case starts" and "turnaround time." Control charts indicated that a reasonable performance standard for timely first case starts was "less than 20% of first case delays will be related to anesthesia activities." For turnaround time, the standard was set at "less than 10% of all turnaround times will be greater than 15 minutes, because of anesthesia-related activities." After instituting performance standards, the performance for first case start times improved from a 36% defective rate to a 9% defective rate. Anesthesia-related delays in turnaround times stabilized at a 16% defective rate. Using appropriate service standards can improve performance.
Serious and undesirable events in health care organizations should trigger analysis and response to minimize the risk of recurrence. Sentinel Events: Evaluating Cause and Planning Improvement, a new book from the Joint Commission, describes the types of errors and sentinel events that have been reported in health care organizations, how organizations can respond to these events, how sentinel events are investigated through root cause analysis, and the Joint Commission's policy on sentinel events. Several case studies and examples demonstrate successful event investigation and improvement efforts in health care organizations. This excerpt addresses prevention of sentinel events through proactive, risk-reduction approaches. It is our hope that, even without the stimulus of a sentinel event, organizations will embrace the concept of prospective design and analysis of health care processes and systems to minimize the possibility of errors and to protect patients from the effects of errors that do occur.
OBJECTIVE: To install and successfully use early commercial automatic anesthesia recordkeepers, the Diatek Arkive "Organizer" units, in the operating rooms at a major university medical center. METHODS: Because of the history of previous academic attempts at automatic anesthesia recordkeeping, the units were installed on a "surprise" basis, with hardly any discussion of the devices beforehand. RESULTS: The devices themselves had a number of minor difficulties at the start, most of which were promptly corrected. Eventually the units were in use in all non-cardiac general operating rooms. At one point, usage reached over 90% of possible cases. Continued opposition to the device on the part of certain individuals, coupled with the obsolescence of the present devices in light of new technology, led to the eventual abandonment of the system and removal of the devices from service. DISCUSSION: Total resistance to the new devices on the part of a few vocal faculty members was a major factor in the ultimate downfall of the system. The method of introduction, and especially the lack of involvement of faculty, residents, surgeons, operating room personnel, hospital computer personnel, and the hospital administration in the installation also played a role in the failure of the system. Lack of a workable training mechanism for new residents prevented that user group from rapidly gaining comfort with the systems.