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Continuous quality assurance (QA) in health care has necessitated the adoption of statistical methods developed as industrial process monitoring techniques. One such statistical technique is the cumulative summation (Cusum) methodology, which can monitor continuously a production process and detect subtle deviations from a preset defined level of achievement. The method is practical, simple to apply, easy to introduce and has proved popular with trainees in some specialities. This article introduces the concepts of a sequential analysis, deals with the practical steps of setting up a data collection and monitoring performance for procedures in health care.

For patients undergoing non-cardiac surgery, only those needing heart rate or blood pressure control perioperatively should start β blockers

The problem of \"gaming\" cardiac surgery outcomes by avoiding high risk patients was proposed and investigated at the time of the initial publication of the results and no evidence was found to support the assertion. 2 More recently it has been suggested that without the knowledge of their own mortality or complication rates and those of their colleagues it is not possible for surgeons to obtain full informed consent from their patients. 3 Thus, complication and death rates become a tool for continuous quality improvement, patient information, and informed consent rather than a stick with which to beat the surgeon.

Objective. To assess the reporting of critical incidents by anaesthetic trainees using personal digital assistants. The project also identified the reporting of ‘near miss’ incidents by anaesthetic trainees. Design. Comparison of electronic incident reporting with retrospective case note review of cases in which no incident was reported. Setting. A 400-bed university teaching hospital in Victoria. Participants. Fourteen accredited Australian and New Zealand College of Anaesthetists (ANZCA) registrars and their training supervisors. Interventions. Registrars and supervisors underwent initial training for 1 hour and were provided with ongoing support. The cases and incidents reported to the database using the portable digital assistants were analysed. Main outcome measures. These were the total number of anaesthetics reported to the database; the number of incidents reported to the database; the outcome severity of incidents reported; and the number of incidents detected in the case note review that were not reported to the database. Results. An incident was reported for 156 (3.5%) of 4441 anaesthetic procedures reported to the database. Of these incidents, 72 (46.2%) were ‘near misses’. One incident was identified in a review of 208 case notes, which had no incidents reported electronically, and was not reported to the database electronically. This gives a reporting rate of 99.52% [95% confidence interval (CI) 96.9–100%]. Conclusions. ANZCA trainees in routine anaesthetic practice can reliably use mobile computing technology to report critical incidents and ‘near miss’ incident data.

For patients undergoing non-cardiac surgery, only those needing heart rate or blood pressure control perioperatively should start β blockers