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​Vital to quality improvement is measurement, and this applies specifically to implementation of interventions. The chosen measures will help to determine whether an impact is being made (primary outcome), whether the intervention is actually being carried out (process measures), and whether any unintended consequences ensue (balancing measures).

Below are some recommended measures to use, as appropriate, to track your progress. In selecting your measures, consider the following:

  • Whenever possible, use measures you are already collecting for other programs.
  • Evaluate your choice of measures in terms of the usefulness of the final results and the resources required to obtain them; try to maximize the former while minimizing the latter.
  • Try to include both process and outcome measures in your measurement scheme.
  • You may use different measures or modify the measures described below to make them more appropriate and/or useful to your particular setting. However, be aware that modifying measures may limit the comparability of your results to others.
  • Posting your measure results within your hospital is a great way to keep your teams motivated and aware of progress. Try to include measures that your team will find meaningful and exciting (IHI, 2012).

    For more information on measuring for improvement contact the Canadian Patient Safety Institute Central Measurement Team at measurement@cpsi-icsp.ca

Outcome Measures

  1. Per cent of medical and surgical procedures with failure to maintain aseptic technique.
  2. Number of medical and surgical instruments and equipment that failed to be appropriately sterilized.
  3. Per cent of surgical patients with the endotracheal tube wrongly placed during an anesthetic procedure.
  4. Number of inappropriate operations (wrong site, wrong patient or wrong procedure).

Process Improvement Measures

  1. Asepsis:  Refer to the Association of Safe Aseptic Practice's Audit Tool available free upon request at enquiries@antt.org
  2. Percent of intubated patients in which all of the following components are performed:
    • the endotracheal tube is inserted to so the cuff is visualized past the vocal cords.
    • bilateral auscultation is performed to ensure breath sounds are equal and heard in both lungs.
    • symmetrical chest movements are observed.
    • quantitative method to continually analyze end-tidal carbon dioxide level from the time of intubation until extubation or transfer to a postoperative care area.
    • the end tidal CO2 and oxygen saturation alarm is visible and audible to the anesthesiologist or the anesthesia care team personnel at all times.
    • there is continuous use of a device that is capable of detecting disconnection of components of the ventilation system. The device must give an audible signal when its alarm threshold is exceeded.
    • A chest X-ray is performed on patients who remain ventilated in the post-operative period.
  3. Per cent of Surgical Patients with appropriate use of the Surgical Safety Checklist: All three phases - Briefing, Time out and Debriefing.
  4. Percentage of surgical patients who had a pre-procedure verification process.
  5. Percentage of surgical patients that had their procedure site appropriately marked.
  6. Per cent of surgical procedures not started until a time-out is performed and all questions or concerns are resolved.
  7. Per cent of surgical staff that participated in teamwork training.