How NAPA Drives Anesthesia Quality Improvement

As a single-specialty anesthesia organization, NAPA has been a pioneer in reporting, compliance, and education for quality improvement and patient safety. Through deliberate actions and investments, we have created a robust Quality Improvement team with award-winning leadership who are committed to driving patient safety for more than 500 hospitals and ASCs nationwide.

NAPA’s approach to Quality Improvement (QI) focuses on five key areas:

A federally listed PSO
While NAPA has been dedicated to QI for years, our organization took a critical step in 2019. With the NAPA Anesthesia Patient Safety Institute, we became one of only 93 federally listed patient safety organizations (PSOs) in the U.S. through the Agency for Healthcare Research and Quality. Our PSO provides the foundation for our culture of safety. “We can review cases in an environment that is not threatening of repercussions or HIPAA law breaches,” says Joan Zomchick-Martin, CRNA, who supports NAPA quality efforts locally and also provides care at Chestnut Hill Hospital in Philadelphia, PA.

“I don’t think the depth of our program—especially internal review—would have been possible if we did not have our PSO in place,” says Madina Gerasimov, MD, a NAPA quality champion and anesthesiologist at North Shore University Hospital in Manhasset, NY.

Key Performance Indicators for every clinician
Information is power, especially in healthcare. At NAPA, QI is more than just collecting and reporting data to CMS. We maintain a vast clinical-outcomes database, with more than three million case-performance entries. We analyze that data internally and act upon it to improve patient outcomes, including identifying trends and disseminating new evidence-based protocols across our national network.

“Every NAPA clinician receives individual quality Key Performance Indicator (KPI) metrics each month, available through a personal dashboard,” says Zomchick-Martin. “This gives each clinician access to a 360-degree evaluation of what he or she is doing. The goal is always self-improvement. Constructive feedback and continuous clinical education are focused on helping us all be the best we can be for our patients.”

Patient safety initiatives
“Anesthesia clinicians are experts in being prepared,” says Dr. Gerasimov. “It is not just about checking the box, ‘Yes, I evaluated my patient for this or that.’ We think about patient care on a deeper level.” To achieve this, NAPA’s QI team provides programs and resources such as Anesthesia Risk Alerts and Clinical Practice Advisories.

Anesthesia Risk Alerts is an internal patient-safety program that requires every clinician assess each patient for five high-risk clinical scenarios. If applicable, the anesthesia team then performs a required mitigation strategy. Compliance with this is documented on the QI form for every case. Clinical Practice Advisories are email messages sent out to every clinician to educate them on a specific clinical topic when the need arises.

During the height of the pandemic, knowledge sharing and access to ever-changing clinical guidance were imperative. “I can’t say enough about what the QI team did to share and disseminate COVID-19 information,” says Zomchick-Martin. “Communication was frequent and readily available to everyone. It was critical to help us protect ourselves and better care for our patients.”

Monthly reviews with clinical leaders
With more than 5,000 NAPA clinicians providing care at hundreds of facilities across 20 states, our teams stay connected through monthly quality meetings in each region. Dividing our national network into regions allows sites in each area to focus on what is happening locally and to see how it fits into national topics or trends. Each site is represented by a quality point person, who then shares feedback from these monthly meetings at the facility level.

“While NAPA is a large organization, we never lose sight of our clinicians,” says Dr. Gerasimov. “Each person who provides patient care is always at the tip of the arrow. We work together to make each clinician the best he or she can be—trained to be the best, educated to be the best, and motivated to stay the best.”

Support for our clinicians
Support for our clinicians begins with our QI team, which serves our clinicians at the organizational level, the regional level, the site level, and even the personal level. Through our PSO, knowledge sharing, and a culture that stresses safety and improvement, we care for our clinicians. Taking this a step further, earlier this year we launched a new initiative, Care for the Caregiver, which provides peer support through adverse events to ensure emotional wellbeing.

“Quality is about patient care, but it is also about caring for our clinicians,” says Zomchick-Martin. When NAPA’s QI program began, it was a small group of people sitting down together, she remembers, as she remarks on the continuous growth of the QI program. “NAPA is made up of administration and leadership who understand that our organization depends on proving we are excellent quality providers,” she says.

“I enjoy using my scientific background to review cases and educate colleagues to help them learn from clinical events,” says Dr. Gerasimov. “I consider it the highest compliment when clinicians tell me they performed well in a challenging case because of what they learned from our QI efforts.”