Outcomes from wake up safe, the pediatric anesthesia quality improvement initiative

Abstract

Background: Wake Up Safe, a Patient Safety Organization founded by the Society for Pediatric Anesthesia, collects data on serious adverse events along with demographic data from all pediatric patients receiving anesthesia care at participating institutions. This report reviews all events occurring between 2010 and 2015 and focuses on common adverse events that are anesthesia-related. Aims: Determine which adverse events were most common from 2010 to 2015 among participating Wake Up Safe institutions. Determine how many anesthesiarelated events were deemed to be preventable. Methods: This is a descriptive report. The Wake Up Safe registry data were queried on September 29, 2017. Institutions were included if they had complete demographic data and at least 5 adverse events per year reported. At that time, 19 out of 29 institutions had complete demographic data for events from 2010 to 2015. This study describes demographic data and adverse events from these nineteen institutions. Descriptive data were extracted, and event rate was calculated for each adverse event category. In events that were assessed as primarily related to anesthesia, further detailed analysis was performed. Results: Of all reported adverse events (2544 events), the most common were cardiac arrests (646, 31.6%), respiratory complications (598, 29.2%), and medication events (345, 16.9%). Of all anesthesia-related events (612 events), medication events were the most common (239, 31.9%), followed by respiratory complications (181, 24.1%), and cardiac arrests (139, 18.5%). Overall, 85% of anesthesia-related serious adverse events were deemed somewhat or almost certainly preventable. Conclusions: The majority of anesthesia-related serious adverse events reported to the Wake Up Safe database are preventable. Medication events are the most common anesthesia-related adverse events. Innovations aimed at decreasing medication events may be the most impactful.

Gastric emptying time of two different quantities of clear fluids in children: A double‐blinded randomized controlled study

“…Perioperative pulmonary aspiration in children remains infrequent and is more likely in emergency situations than in elective surgeries. Its overall incidence in the pediatric population has been estimated to be 0.03%–0.1% 1‐3 . In order to decrease the risk of aspiration, healthy children undergoing elective surgery are traditionally kept fasting overnight to ensure that their stomach is empty.…”

“…Its overall incidence in the pediatric population has been estimated to be 0.03%-0.1%. [1][2][3] In order to decrease the risk of aspiration, healthy children undergoing elective surgery are traditionally kept fasting overnight to ensure that their stomach is empty. Current guidelines recommend fasting of 6-h for solids, 4-h for breast milk, and 2-h for clear fluids prior to anesthesia.…”

From little adults to pediatric patients: quality improvement in pediatric anesthesia

“…The US Society for Pediatric Anesthesia sponsors 'Wake Up Safe', a registry of defined serious adverse events occurring during the perioperative period [14]. Contributing institutions-currently 29 centers in Northern America-report data on patient demographics and adverse events, including a structured analysis of why these events occurred as well as their preventability [15]. The registry was established in order to identify areas in patient care in need of improvement [11].…”

Comment on: Global mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regression

“…In addition, considering that the authors conducted a global review of perioperative cardiac arrests (Table 1), they did not include relevant and important articles found in the PubMed/Medline databases; examples include: Haché et al [ 21 ]; Jansen et al [ 22 ]; Kawashima et al [ 23 ]; Morita et al [ 24 ]; Strøm et al [ 25 ]; and Strøm et al [ 26 ].…”

“…Again, the authors of the review did not include relevant articles found in the PubMed/Medline databases in the forest plot of the perioperative mortality rates (Figs. 2 and 3 are the same); examples include Boonmak et al [ 27 ], Habre et al [ 28 ], Haché et al [ 21 ], Jansen et al [ 22 ], Kawashima et al [ 23 ], Morita et al [ 24 ], Strøm al. [ 25 ], and Strøm et al [ 26 ].…”