{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:14:38Z","timestamp":1789604078958,"version":"build-2803163510"},"reference-count":36,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,7,4]],"date-time":"2018-07-04T00:00:00Z","timestamp":1530662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Inappropriate dosing of neostigmine for antagonism of neuromuscular blockade has been associated with postoperative pulmonary complications. We evaluated the effects of a quality improvement initiative tailored to optimise the use of neostigmine in antagonising neuromuscular blockade on postoperative pulmonary complications, costs and duration of hospital stay. The quality improvement initiative consisted of: a reduction in available neostigmine aliquot sizes; a cognitive aid; an educational component; and a financial incentive for the intra\u2010operative documentation of train\u2010of\u2010four measurement before administration of neostigmine. We conducted a pre\u2010specified analysis of data obtained in our quality improvement study. Additional analyses were conducted in a propensity\u2010matched cohort. An interrupted time series design was used to discriminate between the intervention and a counterfactual scenario. We analysed 12,025 consecutive surgical cases performed in 2015. Postoperative pulmonary complications occurred in 220 (7.5%) of 2937 cases pre\u2010intervention and 568 (6.3%) of 9088 cases post\u2010intervention. Adjusted regression analyses showed significantly a lower risk of postoperative pulmonary complications (OR 0.73 (95%\n                    <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                    0.61\u20130.88); p = 0.001), lower costs (incidence rate ratio 0.95 (95%\n                    <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                    0.93\u20130.97); p &lt; 0.001) and shorter duration of hospital stay (incidence rate ratio 0.91 (95%\n                    <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                    0.87\u20130.94); p &lt; 0.001) after implementation of the quality improvement initiative. Analyses in a propensity\u2010matched sample (n = 2936 per group) and interrupted time series analysis (n = 27,202 cases) confirmed the findings. Our data show that a local, multifaceted quality improvement initiative can enhance the quality of intra\u2010operative neuromuscular blocking agent utilisation, thereby reducing the incidence of postoperative pulmonary complications.\n                  <\/jats:p>","DOI":"10.1111\/anae.14326","type":"journal-article","created":{"date-parts":[[2018,7,5]],"date-time":"2018-07-05T02:49:14Z","timestamp":1530758954000},"page":"1067-1078","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Implementation of a new strategy to improve the peri\u2010operative management of neuromuscular blockade and its effects on postoperative pulmonary complications"],"prefix":"10.1111","volume":"73","author":[{"given":"M. I.","family":"Rudolph","sequence":"first","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. V.","family":"Chitilian","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. Y.","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Harvard Medical School Boston MA USA"},{"name":"Adult Intensive Care Unit Queen Mary Hospital The University of Hong Kong Pok Fu Lam Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. P.","family":"Timm","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. V.","family":"Agarwala","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. B.","family":"Doney","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. K.","family":"Ramachandran","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. T.","family":"Houle","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Eikermann","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr An\u00e4sthesiologie und Intensivmedizin Universit\u00e4tsklinikum Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,7,4]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aex318"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002670"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000865"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000757"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0b013e32835dccd7"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0b013e31816d1268"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31819faa71"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e318182af3b"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000001513"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181da8312"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000440"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000674"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002015"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i6635"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14039"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002220"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2008.05867.x"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e318293065c"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e318219d5f9"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3181fc6e0a"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280206074463"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1080\/00273171.2011.568786"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2013.08.002"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/37.3-4.409"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.13763"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000261"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000760"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aei240"},{"key":"e_1_2_6_32_1","first-page":"e008592","article-title":"Promoting professional behaviour change in healthcare: what interventions work, and why? A theory\u2010led overview of systematic reviews","volume":"5","author":"Johnson MJ","year":"2015","journal-title":"British Medical Journal Open"},{"key":"e_1_2_6_33_1","first-page":"75","article-title":"Changing physician behavior: what works?","volume":"21","author":"Mostofian F","year":"2015","journal-title":"American Journal of Managed Care"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000809"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001893"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/chp.1340220408"},{"key":"e_1_2_6_37_1","first-page":"CD009255","article-title":"An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes","volume":"6","author":"Flodgren G","year":"2011","journal-title":"Cochrane Database of Systematic Reviews"}],"container-title":["Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fanae.14326","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anae.14326","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T21:39:38Z","timestamp":1761687578000},"score":1,"resource":{"primary":{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/10.1111\/anae.14326"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,4]]},"references-count":36,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2018,9]]}},"alternative-id":["10.1111\/anae.14326"],"URL":"https:\/\/doi.org\/10.1111\/anae.14326","archive":["Portico"],"relation":{},"ISSN":["0003-2409","1365-2044"],"issn-type":[{"value":"0003-2409","type":"print"},{"value":"1365-2044","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,4]]},"assertion":[{"value":"2018-04-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-07-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}