Perioperative structure and process quality and safety indicators: a systematic review

Background: Clinical indicators assess healthcare structures, processes, and outcomes. While used widely, the exact number and level of scientific evidence of these indicators remains unclear. The aim of this study was to evaluate the number, type, and evidence base of clinical process and structure indicators currently available for quality and safety measurement in perioperative care. Methods: We performed a systematic review searching Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Google Scholar, and System for Information in Grey Literature in Europe databases for English language human studies in adults (age >18) published in the past 10 years (January 2005eJanuary 2016). We also included professional and governmental body publications and guidelines describing the development, validation, and use of structure and process indicators in perioperative care. Results: We identified 43 860 journal articles and 43 relevant indicator program publications. From these, we identified a total of 1282 clinical indicators, split into structure (36%, n = 463) and process indicators (64%, n = 819). The dimensions of quality most frequently addressed were effectiveness (38%, n = 475) and patient safety (29%, n = 363). The majority of indicators (53%, n = 675) did not have a level of evidence ascribed in their literature. Patient-centred metrics accounted for the fewest published clinical indicators. Conclusions: Despite widespread use, the majority of clinical indicators are not based on a strong level of scientific evidence. There may be scope in setting standards for the development and validation process of clinical indicators. Most indicators focus on the effectiveness, safety, and efficiency of care. PROSPERO database: CRD4201501277.