ABA Quality Assurance & Continuous Improvement 3 — Questions and Answers
Question 1: Which quality improvement methodology uses 'Define, Measure, Analyze, Improve, Control' (DMAIC) as its core framework?
- Lean
- Six Sigma (Correct answer)
- Total Quality Management
- PDSA
Correct answer: Six Sigma
Six Sigma uses the DMAIC framework to reduce process variation and defects toward a target of 3.4 defects per million opportunities.
Question 2: A fishbone (Ishikawa) diagram is used in QI to:
- Track outcome trends over time
- Categorize and visualize potential causes of a problem (Correct answer)
- Prioritize improvement projects by impact
- Display the frequency distribution of adverse events
Correct answer: Categorize and visualize potential causes of a problem
Fishbone diagrams organize potential causes into categories (e.g., people, process, equipment) to systematically identify root causes.
Question 3: When evaluating anesthesia quality, 'risk-adjusted' outcome data is important because:
- It removes all variability from the data
- It accounts for differences in patient complexity when comparing providers or institutions (Correct answer)
- It ensures all patients receive the same treatment
- It eliminates the need for control charts
Correct answer: It accounts for differences in patient complexity when comparing providers or institutions
Risk adjustment controls for patient case-mix differences, allowing fair comparisons of outcomes across providers or facilities.
Question 4: In a quality improvement project targeting PONV reduction, which outcome measure is MOST directly relevant?
- Length of surgery
- PACU rescue antiemetic administration rate (Correct answer)
- Intraoperative blood pressure variability
- Preoperative fasting duration
Correct answer: PACU rescue antiemetic administration rate
Rescue antiemetic rate in the PACU directly measures the burden of PONV and the effectiveness of prophylactic strategies.
Question 5: The concept of 'high reliability organization' (HRO) in healthcare emphasizes:
- Punishing errors to deter future mistakes
- Preoccupation with failure and collective mindfulness to prevent errors (Correct answer)
- Reducing documentation to improve efficiency
- Standardizing all clinical decisions regardless of patient context
Correct answer: Preoccupation with failure and collective mindfulness to prevent errors
HROs proactively search for vulnerabilities and near-misses, fostering a culture of safety before errors cause harm.
Question 6: A 'run chart' differs from a control chart in that a run chart:
- Cannot detect trends
- Does not have statistically derived control limits (Correct answer)
- Only displays categorical data
- Must have at least 100 data points to be valid
Correct answer: Does not have statistically derived control limits
Run charts plot data over time without control limits, using run rules to detect non-random patterns such as trends or shifts.
Question 7: Peer review of anesthesia cases is protected from legal discovery in most U.S. states primarily under:
- HIPAA privacy regulations
- State peer review protection statutes (Correct answer)
- The Affordable Care Act
- Federal antitrust law
Correct answer: State peer review protection statutes
State peer review statutes protect QA/QI deliberations from legal discovery to encourage candid discussion of adverse events.
ABA Quality Assurance & Continuous Improvement 3
Which quality improvement methodology uses 'Define, Measure, Analyze, Improve, Control' (DMAIC) as its core framework?