FANZCA Quality Assurance and Improvement 2 — Questions and Answers
Question 1: In the context of anaesthesia quality improvement, what does the term 'near miss' refer to?
- An adverse event that caused minor patient harm
- An unplanned event that did not reach the patient but had potential to cause harm (Correct answer)
- A sentinel event requiring mandatory reporting
- A medication error that was corrected after administration
Correct answer: An unplanned event that did not reach the patient but had potential to cause harm
A near miss is an unplanned event that did not reach the patient but had the potential to cause harm, providing a valuable learning opportunity without patient injury.
Question 2: Which statistical tool is used in anaesthesia quality monitoring to distinguish between common-cause variation and special-cause variation in process data over time?
- Pareto chart
- Statistical process control (SPC) chart (Correct answer)
- Fishbone diagram
- Run chart without control limits
Correct answer: Statistical process control (SPC) chart
Statistical process control charts use upper and lower control limits to distinguish between common-cause (inherent) variation and special-cause variation requiring investigation.
Question 3: The FANZCA fellowship standard requires participation in quality improvement activities. Which of the following BEST describes a quality improvement project versus a research project?
- QI uses randomization while research does not
- QI aims to improve local systems using existing knowledge; research aims to generate new generalizable knowledge (Correct answer)
- QI requires ethics committee approval while research does not
- QI is conducted only by senior consultants while research involves trainees
Correct answer: QI aims to improve local systems using existing knowledge; research aims to generate new generalizable knowledge
Quality improvement projects apply existing evidence to improve local systems and processes, whereas research is designed to generate new generalizable knowledge.
Question 4: In a root cause analysis (RCA) following an anaesthetic adverse event, which team composition is MOST appropriate?
- The anaesthetist involved in the event only
- Hospital administrators and risk managers only
- A multidisciplinary team including those involved and process experts, excluding blame-focused individuals (Correct answer)
- Only senior anaesthetists not involved in the case
Correct answer: A multidisciplinary team including those involved and process experts, excluding blame-focused individuals
RCA is most effective with a multidisciplinary team including those with direct knowledge of the event and process experts, conducted in a blame-free environment focused on systems.
Question 5: The Donabedian model for evaluating healthcare quality consists of which three dimensions?
- Safety, effectiveness, and patient-centeredness
- Structure, process, and outcomes (Correct answer)
- Input, throughput, and output
- Prevention, treatment, and rehabilitation
Correct answer: Structure, process, and outcomes
The Donabedian model evaluates healthcare quality through structure (resources and settings), process (care delivery activities), and outcomes (effects on patients).
Question 6: When auditing anaesthetic records for compliance with documentation standards, which approach BEST reflects a quality improvement cycle?
- Identify gaps, implement education, re-audit to assess change, and continue the cycle (Correct answer)
- Identify gaps and report them to hospital administration only
- Identify gaps and discipline non-compliant staff
- Audit once annually and publish results without follow-up
Correct answer: Identify gaps, implement education, re-audit to assess change, and continue the cycle
A quality improvement cycle (Plan-Do-Study-Act) requires re-auditing after interventions to determine if changes led to measurable improvement.
Question 7: Which of the following BEST describes the purpose of a mortality and morbidity (M&M) conference in anaesthesia departments?
- To assign blame and disciplinary action to responsible clinicians
- To provide a structured forum for learning from adverse events and improving systems (Correct answer)
- To fulfill medicolegal documentation requirements only
- To compare individual anaesthetist performance for credentialing purposes
Correct answer: To provide a structured forum for learning from adverse events and improving systems
M&M conferences are educational forums designed to review adverse events and complications in a blame-free environment to identify system improvements and prevent recurrence.
FANZCA Quality Assurance and Improvement 2
In the context of anaesthesia quality improvement, what does the term 'near miss' refer to?