In Reply:-Dr. Lagasse's correspondence begins by stating that Sanborn et al. "suggests that automated anesthesia records can identify, track and report deviations from specific limits for physiologic variables and that this might be preferable to self-reporting of adverse events." He disagrees, and supports his disagreement by reference to his own data, based on review of hand-kept records, which have been demonstrated to be notoriously unreliable. [2,3]
In fact, we demonstrated that automated anesthesia records can identify, track and report deviations from specific limits for physiologic variables but we never stated that this might be preferable to self-reporting of adverse events. We do not dispute that voluntary self-reporting of intraoperative incidents is the centerpiece of QI programs in anesthesia. Indeed, in order to emphasize that electronic detection of intraoperative incidents is only useful for a limited set of patient variables, we stated that
"While events such as cardiac arrhythmias, repeated attempts at intubation, mechanical failures, nerve injury, intraoperative awareness, failed regional block, bronchospasm, vomiting and many others may all be important to patient outcome, they are not readily detectable by electronic scanning of an AAR (automated anesthesia record) database." (page 984)
Our scientific goals were clearly stated in the introduction. The purpose of our report was not to evaluate our QI program, or to compare it to Dr. Lagasse's QI program. Misunderstanding this, Dr. Lagasse presents readers with a comparison of his QI program, based on outcome measures and dependent upon hand-kept records, versus our study of selected process measures, using automated records. However important outcome is to QI, analysis of process measures is required by JCAHO.*
We appreciate Dr. Lagasse's enthusiasm for better QI, and we agree with his opinions about the importance of voluntary reporting. However, we cannot share his faith in QI systems which place the total burden of recording and reporting on us imperfect humans.
Kevin V. Sanborn, M.D.
Associate Professor of Clinical Anesthesiology
Columbia University; Department of Anesthesiology; St. Luke's-Roosevelt Hospital Center; Amsterdam Avenue at 114th Street; New York, New York 10025
(Accepted for publication June 25, 1997.)
*Improving Organizational Performance. In "1995 Comprehensive Accreditation Manual for Hospitals" Joint Commission on Accreditation of Healthcare Organizations. Oakbrook Terrace, IL 1994, pp 219-66.