This Quality Improvment form is implemented by the Stanford University Department of Anesthesiology, Perioperative and Pain Medicine.

Designed by: Quality, Efficiency and Patient Safety Committee (QEP)

Online electronic capture system designed and implemented by: Larry Chu, MD, Professor and Stanford AIM Lab

Important Information

Who has access to this information and how is it protected?

  • Access Restricted
    • Information not saved in or associated with Epic/EHR
    • All information stored in HIPAA-secure Stanford REDCap Database
    • Maintained by Stanford AIM Lab/Department of Anesthesia
  • Identity Information Restricted
    • The information submitted is Protected under California Evidence Code 1157
    • Information submitted is for the sole purpose of evaluation and improvement of quality of care
    • Case identifiers and personal information restricted to QI subcommittee access
    • Provider identifier information restricted to QI subcommittee access
      • Option to submit anonymously (no identifying information collected)
      • All submissions are confidential (identifying information kept private)

Page 1 of 3

Loading... Loading...
You have selected an option that triggers this survey to end right now.
To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.