Quality improvement is designed to reduce error and improve process and outcomes and is just as important for children as it is for adults who undergo surgery and anesthesia. (Image source: Thinkstock)

Quality improvement is designed to reduce error and improve process and outcomes and is just as important for children as it is for adults who undergo surgery and anesthesia. (Image source: Thinkstock)

Try searching for articles that are concerned with total quality management and perioperative care. You will find nearly 200 articles.  Next, try limiting the articles to only infants.  The total?  0.  Include children and there are 12.

Dr. Anna M. Varughese, Department of Anesthesia, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH and colleagues provide an overview of quality improvement within pediatric anesthesiology.  Their study, entitled “Quality and Safety in Pediatric Anesthesia,” is published in this month’s issue of Anesthesia & Analgesia.

The authors note initially that quality improvement is designed to reduce error and improve process and outcomes.  Examples of institutional quality and safety initiatives within pediatric anesthesiology include:

  1. Safe handoff of patient care, which includes handoffs between the perioperative team and different critical care units, as well as the PACU and also between anesthesia providers in the OR.  Drivers for the process include identification and knowledge of critical elements, transfer of the information, and participation of all relevant parties.   Use of checklists is an important part of the process
  2. Perioperative blood management.  The purpose of this initiative is to reduce intraoperative blood use and reduce coagulopathy as a reason for postoperative bleeding.   It is important to be conscious of the need for lower hemoglobin thresholds.  After protocol implementation at one institution, there was a reduction in both blood product use as well as coagulopathy.
  3. Perioperative blood wastage reduction.  One group examined factors that were most amenable to change that had an impact on blood wastage.  These included lack of awareness, training of staff who handled blood products, management of temperature-validated containers, proper interpretation of RBC temperature indicators, and accountability for those who ordered blood products.
  4. Reduce bloodstream infections. This included multiple procedural changes, such as improving stopcocks used for medication, easier access to hand gel and trash bags, and changes of the anesthesia workspace organization by division into clean and dirty areas.

Clearly more can be done.  As the authors state, within the past 5 years, there have been several initiatives that have been started to address safety within pediatric anesthesiology.  These include (a) Wake Up Safe, which allows for institutions to provide adverse data by self-report (a cluster of wrong-side procedures was identified in this way), and (b) The Pediatric Regional Anesthesia Network (PRAN), which provides data on regional anesthesia including complications.

The authors are to be congratulated for advancing our understanding of quality and safety improvements in pediatric anesthesiology.