• I Odin, J C Merle, P Feiss, and N Nathan.
• Département d'anesthésie-réanimation, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France. isabelle.odin@unilim.fr
• Ann Fr Anesth Reanim. 2003 Oct 1; 22 (8): 697-703.

ObjectivesTo report the efficiency and direct cost induced by a quality insurance programme (QIP) aimed to reduce the incidence of post-operative nausea and vomiting (PONV) in the post-anaesthesia care unit.Type Of StudyProspective and descriptive study.MethodsThe occurrence and treatment of PONV were prospectively recorded in the post-anaesthesia care unit in a standardised file before and following therapeutic recommendations made by volunteers component of a QIP. Prophylaxis was administered to patients according to a score of risks based on the type of surgery and patient characteristics. The real cost induced by this change of practice was evaluated according to pharmacists' accounts over 1 year.ResultsThe QIP was associated to a 33.5% reduction of PONV relative risk and a 50% increase in prophylactic treatments. When this reduction of PONV was extrapolated to the total number of anaesthesia over 1 year, this QIP avoided PONV in 770 patients each year. The increase of cost reached 3572 as the cost by patient receiving a prophylactic treatment increased from 0.66 to 1.ConclusionDespite an increase in the individual cost of PONV prophylaxis, the selection of patients by a "home" score of risk limits the indications of prophylactic treatment. Thus the increase in cost remains in acceptable ranges.

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