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Using an International Clinical Registry of Regional Anesthesia to Identify Targets for Quality Improvement
  1. Brian D. Sites, MD, MS*,
  2. Michael J. Barrington, MBBS, FANZCA, PhD and
  3. Matthew Davis, PhD, MPH
  1. *Department of Anesthesiology and Pain Management, Dartmouth-Hitchcock Medical Center, Lebanon, NH
  2. Department of Anaesthesia, St Vincent’s Hospital, and Melbourne Medical School, The University of Melbourne, Melbourne Victoria, Australia
  3. The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
  1. Address correspondence to: Brian D. Sites, MD, Department of Anesthesia and Pain Management, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756 (e-mail: brian.sites{at}hitchcock.org).

Abstract

Background Despite the widespread use of regional anesthesia, limited information on clinical performance exists. Institutions, therefore, have little knowledge of how they are performing in regard to both safety and effectiveness. In this study, we demonstrate how a medical institution (or physician/physician group) may use data from a multicenter clinical registry of regional anesthesia to inform quality improvement strategies.

Methods We analyzed data from the International Registry of Regional Anesthesia that includes prospective data on peripheral regional anesthesia procedures from 19 centers located around the world. Using data from the clinical registry, we present summary statistics of the overall safety and effectiveness of regional anesthesia. Furthermore, we demonstrate, using a variety of performance measures, how these data can be used by hospitals to identify areas for quality improvement. To do so, we compare the performance of 1 member institution (a US medical center in New Hampshire) to that of the other 18 member institutions of the clinical registry.

Results The clinical registry contained information on 23,271 blocks that were performed between June 1, 2011, and May 1, 2014, on 16,725 patients. The overall success rate was 96.7%, immediate complication rate was 2.2%, and the all-cause 60-day rate of neurological sequelae was 8.3 (95% confidence interval, 7.2– 9.7) per 10,000. Registry-wide major hospital events included 7 wrong-site blocks, 3 seizures, 1 complete heart block, 1 retroperitoneal hematoma, and 3 pneumothoraces. For our reference medical center, we identified areas meriting quality improvement. Specifically, after accounting for differences in the age, sex, and health status of patient populations, the reference medical center appeared to rely more heavily on opioids for postprocedure management, had higher patient pain scores, and experienced delayed discharge when compared with other member institutions.

Conclusions To our knowledge, this is the first large-scale effort to use a clinical registry to provide comparative outcome rates representing the safety and effectiveness of regional anesthesia. These results can be used to help inform quality improvement strategies.

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Footnotes

  • This work should be credited to the International Registry of Regional Anesthesiology.

    M.J.B. acknowledges financial support from the Australian and New Zealand College of Anaesthetists in the form of scholarship (10/023) and project (14/030) grants.

    The authors declare no conflict of interest.

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