North American Partners in Anesthesia (NAPA) is a nationwide anesthesia practice with more than 450 facilities in 21 states. NAPA employs anesthesiologists, certified registered nurse anesthetists, and certified anesthesiologist assistants. The Anesthesia Risk Alert program is a protocol created as a work product by NAPA’s component Patient Safety Organization, the NAPA Anesthesia Patient Safety Institute (NAPSI), which monitors patients for specific high-risk clinical factors and trains providers to apply targeted mitigation interventions when patients are considered at risk.¹ The interventions are based on well-researched practices and clinical guidelines and were informed by an analysis of three years of adverse event data across NAPA by NAPSI, referred to throughout as the innovator. This data analysis revealed five high-risk clinical scenarios. The NAPSI team created a detailed program for providers to respond to each of the five scenarios.

The innovation was developed from an initial quality improvement project and was piloted among New York NAPA hospitals.¹ The pilot started as a precautionary practice of noticing high-risk clinical scenarios prior to patients undergoing a procedure wherein clinicians respond with a specific risk mitigation strategy. This proactive approach permits clinicians to focus on specific patient risk factors and respond with the best intervention to prevent potential adverse events.

• Coordinator to orchestrate and implement the innovation across providers.
• Dashboards to drive conversations in monthly quality meetings.
• Data-driven talking points shared at monthly quality meetings.
• Data dissemination methods via texts and emails to providers to encourage ongoing documentation and increases in compliance.
• Monthly staff meetings conducted by leaders with providers to discuss compliance strengths and gaps, and to give data-driven feedback.
• Data analysis of adverse events.
  • Investing resources into strong data collection and data analytics supported the NAPSI team’s ability to identify their five high-risk clinical scenarios to decrease adverse events.
• Expertise to perform data analytics and to design information technology dashboards (to track compliance and adverse events in Microsoft Power Business Intelligence).
• Clear documentation of adverse events in a NAPSI quality reporting platform.
• Compliance tracking of patient screenings for the five high-risk scenarios. When a positive screen occurs, documentation of whether or not the mitigation strategy was applied.
• Leadership to manage implementation and ongoing feedback to providers.

Currently, NAPSI’s Anesthesia Risk Alert program is being used across NAPA’s nationwide practices including 450 facilities (hospitals, ambulatory surgery centers, and office-based health care providers) among 6,000 anesthesiologists, certified registered nurse anesthetists, and certified anesthesiologist assistants in 21 states. No other organizations use the Anesthesia Risk Alert program.