Quality in anesthetic management during hepatic transplant. Hepatic Transplant Anesthesia Group

INTRODUCTION: To measure the quality of anesthetic management during liver transplants (LT) and to assess the effect on improving patient care after establishing a quality policy based on self evaluation of quality indicators. MATERIAL AND METHODS: Two periods were studied: January 1993 through December 1994 (93 LT) and March 1995 through November 1995 (45 LT). Compliance with the anesthetic protocol was assessed by way of 14 indicators as follows: exposure and analysis of the results for the 1993-1994 period followed by later evaluation of quality indicators for the period 1995. RESULTS: The index for revascularization of the graft was lower than any of the following six indicators: temperature, systolic arterial pressure, hemoglobin, fibrinogen, pH value and sodium values over 155 mmol/l. In the phase during which the liver was removed, the indicator for calcium level lower than 1 mmol/l was the only indicator with low compliance. Multiple regression analysis showed that mechanical ventilation was associated to transfusion requirements, to non compliance with hemostatic and coagulation indicators, and to presence of a decrease in systolic arterial pressure below 70 mmHg. CONCLUSION: We conclude that adverse effects can be partially improved by implementing a quality policy based exclusively on analysis of results and ongoing professional training. The impact of non compliance with the indicators, policy structure and process of delivering health care should be explored.