Anesthesiology Quality Assurance & Performance Improvement

Montefiore Einstein Anesthesiology is committed to continuous improvement. We are continually working to advance our quality assurance mechanisms and performance improvement initiatives to enhance patient care, safety and outcomes.

Linking our clinical research and bedside care, Montefiore Einstein Anesthesiology prioritizes quality assurance. Together with our nursing and medicine colleagues, we routinely track key outcomes and process measures and work to address any issues during the perioperative process. For example, we analyze the efficient transfer of patients, the postoperative respiratory failure rates (patients safety indicator (PSI) 11), postoperative venous thromboembolism (PSI 12) and postoperative early mobilization. We are constantly working to improve our quality assurance mechanisms through a proactive, multidisciplinary approach.

The Anesthesiology Critical Care Medicine quality assurance team recently developed a new intensive care unit (ICU) quality improvement (QI) database, which has been a valuable resource in studying the impact of interventions on patient outcomes. In a recently completed study evaluating surgical intensive care unit (SICU) outcomes, we found improvements in the duration of invasive ventilation, a lower incidence of respiratory failure, and a lower proportion of deep sedation. The team has also minimized catheter-associated urinary tract infections (CAUTI) and has achieved a one-year zero-percent rate of central line-associated bloodstream infection (CLABSI). Some of our other quality improvement initiatives include the following: 

• Expanding our critical care medicine footprint outside of the SICU to prevent failure to rescue. In this initiative led by William Sauer, MD, and Michael Kiyatkin, MD, six physician assistants have been brought on to provide extended coverage in the SICU, post anesthesia care unit (PACU), and step-down unit (SDU). The team has also created escalation criteria for bedside registered nurses (RNs) and surgical providers to enhance the care of our most vulnerable patients. In addition, the team has reduced the time patients need to stay in the step-down unit, which is a great indication of faster recovery due to excellent treatment.
• Development of the Difficult Airway Response Team (DART), a multidisciplinary initiative led by Michael Kiyatkin, MD, to improve the management of difficult airways outside of the operating room. Dr. Kiyatkin and other members of DART, including Drs. Straker, Osborn, Fassbender and Kitz, received the 2024 Montefiore Einstein Patient Safety Recognition Award for their work.
• Instituting early ambulation for high-risk patients in order to optimize their outcomes. This initiative involves an interprofessional effort with nursing as well as physical therapy and includes the implementation of a SICU Optimal Mobilization Score (SOMS) algorithm to assess which patients have the highest need for early mobilization.

Montefiore Einstein Anesthesiology has successfully collaborated with the Montefiore Einstein Network Performance Group to boost the health system’s national ratings. Determined by the Centers for Medicare and Medicaid Services (CMS), the CMS Star Rating system takes into account a number of metrics, including patient safety indicators (PSIs)—improvements to which have already been shown to enhance patient outcomes. Our innovations have led to reductions in postoperative respiratory failure and thromboembolic events.

• We served as the Montefiore Einstein champion for an interdisciplinary project aimed at reducing the incidence of the Centers for Medicare and Medicaid Services (CMS PSI 11 (postoperative respiratory failure rate) and PSI 12 (perioperative pulmonary embolism or deep vein thrombosis rate). We also support our colleagues in the cardiovascular ICUs in an effort to decrease the risk of postoperative respiratory failure.
• The quality improvement team recently completed a study evaluating outcomes in the SICU from 2019 and 2023 and found improvements in the duration of invasive ventilation, a lower incidence of respiratory failure and a lower proportion of deep sedation. It is important to reduce deep sedation for patients in the ICU because it is associated with a higher risk for prolonged intubation, respiratory failure and delirium.
• Our physician-scientists also developed novel, machine-learning-powered automated prediction tools to help determine which patients are at high risk for same-day case cancellation and postoperative respiratory failure. Physiological and procedural data were at the core of the latter model, which was recently implemented system-wide via a collaboration with the Montefiore Einstein Center for Health Data Innovations.
• Christopher Tam, MD, Director of the Anesthesiology Critical Care Medicine Fellowship, served as a 2024 Montefiore Einstein Health System Performance Improvement Fellow and championed an effort to reduce the incidence of perioperative pulmonary embolism or deep vein thrombosis (PSI 12). As such, Dr. Tam collaborated with Fran Ganz-Lord, MD, Assistant Vice President for Quality and Performance Improvement, and the Department of Pharmacy to develop new guidelines on administering chemoprophylaxis in surgical patients. As part of the project, the Anesthesiology Digital Health Laboratory developed a prediction model to identify patients who are at an increased risk of a thromboembolic event, which is part of a bundle intervention designed to improve patient safety and lead to better patient outcomes. Dr. Tam was recognized for his leadership of this project with the Montefiore Einstein Performance Improvement Project of the Year Award.