Paediatric anaesthesia
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Measurement of quality and improvement in medicine has existed since Florence Nightingale's time. In modern times, medicine has sought to learn from other high-reliability industries such as aviation and nuclear power, where errors can result in catastrophic outcomes. Lean is a unique quality improvement strategy that seeks to improve both quality and safety by driving out waste and, where possible, standardizing work practices. ⋯ The improvement efforts are always viewed from the perspective of the customer, our patients, families, and coworkers. This paper describes the evolution of Lean in healthcare and highlights core principles of Lean. Examples are used to describe how various Lean tools can be applied by pediatric anesthesiologists to solve clinical problems.
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Paediatric anaesthesia · Nov 2022
ReviewImplementation of an electroencephalogram-guided propofol anesthesia education program in an academic pediatric anesthesia practice.
Propofol total intravenous anesthesia (TIVA) is increasingly popular in pediatric anesthesia, but education on its use is variable and over-dosage adverse events are not uncommon. Recent work suggests that electroencephalogram (EEG) parameters can guide propofol dosing in the pediatric population. This education quality improvement project aimed to implement a standardized EEG TIVA training program over 12 months in a large pediatric anesthesia division. ⋯ This quality improvement education project successfully trained pediatric anesthesia faculty, staff, residents, and fellows in EEG-guided TIVA. The training program was effective, scalable, and sustainable over time for newly hired faculty staff and rotating fellows and residents.
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Paediatric anaesthesia · Nov 2022
ReviewHow the Wake Up Safe Pediatric Anesthesia Collaborative Increased Quality Improvement Capability and Collaboration.
Wake Up Safe is a patient safety organization consisting of 40 institutions with a mission to improve the processes of care and outcomes for newborns, infants, and children having anesthesia for surgery and medical procedures. It was recognized that the level of quality improvement (QI), knowledge, and experience varied greatly between member institutions. In Fiscal Year 2015, the group's leadership created a subcommittee on QI and education in efforts to provide member institutions with the skills and resources to use QI methodology to improve care at their own institution. ⋯ This review describes the development and implementation of this initiative. As a result of this initiative, significant progress was made improving the QI capability of the collaborative over a two-year period. This educational and support program included workshops, an online discussion forum, site visits, and project presentations.
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Paediatric anaesthesia · Nov 2022
The emergence noise reduction quality improvement initiative to enhance patient safety and quality of care.
Operating room noise levels may hinder staff communication and cause distractions for providers, endangering patient safety. Owing to concerns of unacceptable noise levels during emergence from general anesthesia, our institution developed a quality improvement project. The SMART aim of this initiative was to decrease the average decibel noise level measured during emergence from general anesthesia in our operating rooms from 65.65 to 63 decibels and the maximum decibel noise level from 81.64 to 75 decibels over approximately 3 months. ⋯ This improvement project was associated with a decrease in decibel noise levels during emergence. We enhanced a process and encouraged culture change at an academic pediatric hospital to enhance the safety of our care.