Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Aug 2021
Hospital safety-net burden is associated with increased inpatient mortality after elective total knee arthroplasty: a retrospective multistate review, 2007-2018.
Total knee arthroplasty (TKA) is among the most common surgical procedures performed in the USA and comprises an outsized proportion of Medicare expenditures. Previous work-associated higher safety-net burden hospitals with increased morbidity and in-hospital mortality following total hip arthroplasty. Here, we examine the association of safety-net burden on postoperative outcomes after TKA. ⋯ Patients undergoing TKA at higher safety-net burden hospitals are associated with higher odds of in-patient mortality than those at low safety-net burden hospitals. The source of this mortality differential is unknown but could be related to the increased risk of intraoperative complications at higher burden centers.
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Misalignment of measures, measurement and analysis with the goals and methods of quality improvement efforts in healthcare may create confusion and decrease effectiveness. In healthcare, measurement is used for accountability, research, and quality improvement, so distinguishing between these is an important first step. Using a case vignette, this paper focuses on using measurement for improvement to gain insight into the dynamic nature of healthcare systems and to assess the impact of interventions. ⋯ SPC provides ongoing assessment of system functioning and enables an improvement team to assess the impact of its own interventions and external forces on the system. Once improvement work is completed, the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines is a valuable tool to describe the rationale, context, and study of the interventions. SQUIRE can be used to plan improvement work as well as structure a manuscript for publication in peer-reviewed journals.