Quality indicators for structure and process in peri-operative care: a systematic review

Introduction: Quality indicators are essential for benchmarking, quality assurance and driving improvement in healthcare. Many indicators exist for peri-operative care but their relevance and evidence base vary. This systematic review updates a review published 10 years ago. It seeks to identify available structure and process indicators, and assess the level of evidence supporting them, with a view to informing the development of a core indicator set. Methods: MEDLINE, Embase, CINAHL and the Cochrane Library were searched. English-language studies in adults were included, alongside grey literature from: clinical, professional and governmental organisations; quality standards; and guidelines. Results: There were 657 included studies and grey literature sources, alongside indicators from a previously published review. Of a total 615 indicators (324 process indicators, 248 structure indicators and 43 indicators which were not defined clearly but relevant to process or structure), we identified 380 new indicators. Evidence supported 505 (82%) indicators, while 110 (18%) lacked clear evidence. This compared with 47% and 53%, respectively, in the previous review. Only 12% of the indicators were evaluated for validity. Inconsistencies were noted in definitions, with varying target thresholds reported for the same indicators. Many indicators were developed without the involvement of patients or carers. Discussion: There is a need for standardisation in the development and naming of peri-operative quality indicators. Clear reporting, validation and patient involvement would improve their credibility and utility. Rationalising the current large, overlapping number of indicators is essential to enhance usability and ensure meaningful improvement in peri-operative care.