Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2013
Striving for a zero-error patient surgical journey through adoption of aviation-style challenge and response flow checklists: a quality improvement project.
We describe our aim to create a zero-error system in our pediatric ambulatory surgery center by employing effective teamwork and aviation-style challenge and response 'flow checklists' at key stages of the patient surgical journey. These are used in addition to the existing World Health Organization Surgical Safety Checklists (Ann Surg, 255, 2012 and 44). ⋯ We have created a reproducible model of care involving multiple checklists at high-risk points in the patient surgical journey. The model is reliable and has a high degree of staff engagement. It promotes patient safety by ensuring the patient, team and equipment are correctly configured at every key transition stage in the surgical journey. We have been able to achieve this with no measurable increase in turnover times or reduction in operating room efficiency.
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Paediatric anaesthesia · Jul 2013
Observational StudyA prospective observational quality improvement study of the sustained effects of a program to reduce unplanned extubations in a pediatric intensive care unit.
The use of endotracheal intubation is routine in the care of critically ill children. Unplanned extubation exposes the patient to morbidity and mortality over and above that associated with the patient's underlying disease. All unplanned extubations are unacceptable because of their potential for causing unnecessary harm to the patient. ⋯ In the 9 years since implementation, our program has remained successful in decreasing unplanned extubations. It is important to periodically reevaluate quality improvement programs to determine whether they have continued to achieve their intended goals. The initiative is reported here using the Standards for Quality Improvement Reporting Excellence (SQUIRE).
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Paediatric anaesthesia · Jul 2013
Interventions guided by analysis of quality indicators decrease the frequency of laryngospasm during pediatric anesthesia.
Clinical outcomes in pediatric anesthesia have improved significantly over the last 20-30 years but unexpected laryngospasm that is difficult to treat can still result in patient morbidity, increased postoperative medical management and unnecessary hospital admission. The incidence of laryngospasm in pediatric anesthesia is difficult to determine with incidences from 0.9% to as high as 14% quoted in the literature. Clinical experience in our institution suggests that laryngospasm is one of the more frequent unanticipated complications that occur under general anesthesia. Therefore, we applied quality improvement (QI) methodology to: (i) identify the etiology and contributing factors that lead to unanticipated incidents during pediatric anesthesia care; and (ii) decrease the incidence of laryngospasm during pediatric anesthesia care by focusing on awareness, preparedness, education and knowledge translation. ⋯ We applied QI methodology to identify potential improvements in the quality of anesthesia care we deliver to our patients. By designing a number of key drivers and interventions specifically focused on laryngospasm, we decreased the incidence of unanticipated calls for help due to laryngospasm by 50% and maintained this improvement to clinical care across a 12-month period.
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Paediatric anaesthesia · Jul 2013
Incidence and causes of perioperative endotracheal reintubation in children: a review of 28,208 anesthetics.
To determine the incidence, risk factors, and causes of endotracheal reintubation in children and identify methods to reduce the occurrence. ⋯ The incidence of endotracheal reintubation in children is low, but can result in significant morbidity. Because of the high frequency of inadvertent extubation, a significant number of reintubations could be prevented with greater care during transfer of patients with endotracheal tubes, and in procedures near the airway. Increased vigilance in younger children is also recommended as children under 3 years old required the majority of the reintubations.