We developed a continuous quality improvement (CQI) program for anesthesia services based on self-reporting of critical incidents and negative outcomes through a dichotomous (yes/no) response on the anesthesia record. Immediate case investigation provides data for systematic peer review of anesthesia management. Trend analysis of the database of critical incidents and negative outcomes identifies opportunities for improvement. The CQI program resulted in the reporting of nearly twice as many problems related to anesthesia management (5% of all anesthetics) as did the checklist it replaced (2.7%). Escalation of patient care (3.2%) and operational inefficiencies (2.2%) were more common than patient injury (1.5% of all anesthetics). Among the 537 cases with anesthesia management problems were 119 human errors and equipment problems (22%). Regional nerve blocks and airway management represented the most common problem areas. Improvement in anesthesia services was made through prompt implementation of strategies for problem prevention devised by the practitioners themselves through peer review, literature review, and clinical investigations.