The Anesthesia Perioperative “Call for Help”—Experience at a Quaternary Pediatric Medical Center: Analysis of 67,564 Anesthesia Encounters

Vlassakova, Bistra G.; Sinnott, Sean; Askins, Nissa; Callahan, Matthew; Leahy, Izabela; Zurakowski, David; Hickey, Paul R.; Cravero, Joseph P.

doi:10.1213/ane.0000000000003353

Cited by 17 publications

(18 citation statements)

References 27 publications

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“…Adverse events in cardiac catheterization suites had higher odds of severe outcome compared to the operating room, but this difference was not found in other off-site locations [32]. However, other groups have reported a lower incidence of critical events at off-site locations compared to the operating room [9,10].…”

Section: Non-operating Room Anesthesia (Nora)/sedationmentioning

confidence: 87%

“…They found that higher ASA status, history of respiratory illness, cardiac inciting event, occurrence during induction phase, post anesthesia care unit location, and calls initiated by an attending physician or fellow were more likely to be associated with a complicated STAT call. A subset of 108 calls indicated that age <1 year old and a history of prematurity were independent predictors of higher incidence of STAT calls [10].…”

Section: General Pediatric Perioperative Adverse Events In the Modernmentioning

confidence: 99%

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Hot Topics in Safety for Pediatric Anesthesia

et al. 2020

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Anesthesiology is one of the leading medical specialties in patient safety. Pediatric anesthesiology is inherently higher risk than adult anesthesia due to differences in the physiology in children. In this review, we aimed to describe the highest yield safety topics for pediatric anesthesia and efforts to ameliorate risk. Conclusions: Pediatric anesthesiology has made great strides in patient perioperative safety with initiatives including the creation of a specialty society, quality and safety committees, large multi-institutional research efforts, and quality improvement initiatives. Common pediatric peri-operative events are now monitored with multi-institution and organization collaborative efforts, such as Wake Up Safe.

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Section: Non-operating Room Anesthesia (Nora)/sedationmentioning

confidence: 87%

Section: General Pediatric Perioperative Adverse Events In the Modernmentioning

confidence: 99%

Hot Topics in Safety for Pediatric Anesthesia

et al. 2020

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“…A 2018 study of calls for emergency assistance to the pediatric operating room also observed variation in the frequency of critical events by event type. In 193 calls, 75% were for a respiratory cause, 13% were for a cardiac cause (half were for an arrhythmia), and 1 was for an air embolus 9 . Malignant hyperthermia is also a generally rare critical event occurring in fewer than 1 in 5000 anesthetics 10 …”

Section: Introductionmentioning

confidence: 99%

The timing of cognitive aid access during simulated pediatric intraoperative critical events

Clebone

Watkins

Tung

2020

Pediatric Anesthesia

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Background Many cognitive aids are formatted in a step‐by‐step fashion with the intent that the aid will be accessed at the beginning of a critical event and that key behaviors will be performed in sequence. Aims We hypothesized that, during simulated pediatric intraoperative critical events, anesthesia clinicians may not use cognitive aids immediately after the onset of a critical event but instead access the aid only after first performing several key behaviors. Materials and Methods This manuscript is a re‐analysis of previously published simulation data. The original study involved 89 clinicians participating in 143 pediatric intraoperative events divided into 6 types: arrhythmia, venous air embolus, hypoxemia, malignant hyperthermia, hypotension, and supraventricular tachycardia. For each trial involving cognitive aid use, we measured the time from event trigger to cognitive aid use, and the number and type of key behaviors performed by simulation participants prior to cognitive aid access. Results Cognitive aid use was sought in 66 of 93 trials where it was available. Sufficient data for this analysis were available in 65 trials. The average time from event trigger to first cognitive aid use was 258 seconds. In 62/65 trials (95%), the cognitive aid was accessed after at least one key behavior had already been performed. The time from event trigger to cognitive aid use varied by type of scenario (P = .03, df 5, adjusted H 12.78), with the shortest time for “supraventricular tachycardia” (90 [66,156] seconds (median [IQR]) and the longest time for “hypoxemia” (354 [192,492] seconds). Conclusion In simulated critical events, anesthesia residents and student nurse anesthetists often consulted a cognitive aid only after first performing at least some key behaviors. Incorporating the possibility of delayed access into critical event cognitive aid design may facilitate the effectiveness of that aid.

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“…Kakavouli et al showed no difference in the incidence of AE in off‐site compared to operating room locations when care was provided by anesthesia providers and Vlassakova et al reviewed a single institution's experience with STAT calls (calls for help), finding significantly fewer calls in remote locations compared to traditional ORs. Yet, when calls occurred, there was increased likelihood for the need of care escalation, such as unplanned admission or unplanned transfer to the intensive care unit (ICU) …”

Section: Introductionmentioning

confidence: 99%

“…Yet, when calls occurred, there was increased likelihood for the need of care escalation, such as unplanned admission or unplanned transfer to the intensive care unit (ICU). 8 Given the variability in reported rates of AEs during sedation in off-site locations and the limitations of prior studies (including collection of data from a mix of cases involving anesthesia providers and those involving sedation by non-anesthesia personnel), we analyzed a multi-institutional registry of pediatric patients undergoing procedures under anesthesia by anesthesia providers to assess escalation of care and residual patient harm after AEs. Our primary aim was to compare the likelihood of severe outcome between AEs occurring in the operating room and AEs occurring in off-site locations.…”

Section: Introductionmentioning

confidence: 99%

Severe outcomes of pediatric perioperative adverse events occurring in operating rooms compared to off‐site anesthetizing locations in the Wake Up Safe Database

Uffman

Tumin

Beltran

et al. 2018

Pediatric Anesthesia

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Summary Background Anesthesia services are frequently provided outside of the traditional operating room environment for children. It is unclear if adverse events which occur in off‐site anesthetizing locations result in more severe outcomes compared to events in traditional operating rooms. Aim We used a multi‐institutional registry of pediatric patients to compare outcomes of perioperative adverse events between location types. Methods De‐identified data from 24 pediatric tertiary care hospitals participating in the Wake Up Safe registry during 2010‐2015 were analyzed. Peri‐procedural adverse events occurring in operating rooms or off‐site locations were included. The primary outcome was whether the adverse event was severe, defined as requiring escalation of care or resulting in temporary or significant harm. Multivariable logistic regression was used to compare location type (operating room vs. off‐site) and the likelihood of a severe outcome among reported events. Results There were 1594 adverse events, of which 362 were associated with off‐site anesthetizing locations. In multivariable logistic regression, off‐site location was associated with greater odds of severe adverse event outcome (adjusted odds ratio, 1.31; 95% confidence interval: 1.01, 1.69; P = 0.044). Comparing adverse events in cardiac catheterization suites to events in operating rooms confirmed higher odds of severe outcome in the former group (adjusted odds ratio = 1.48; 95% confidence interval: 1.05, 2.08; P = 0.025), while this difference was not found for other off‐site locations. Conclusion Multivariable analysis of a large registry revealed a greater likelihood of severe outcome for adverse events occurring in cardiac catheterization suites (but not other out of the OR sites), compared to adverse events occurring in the operating room. Additional prospective studies are needed which better control for patient and environmental characteristics and their effect on severe outcomes after anesthesia.

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The Anesthesia Perioperative “Call for Help”—Experience at a Quaternary Pediatric Medical Center: Analysis of 67,564 Anesthesia Encounters

Cited by 17 publications

References 27 publications

Hot Topics in Safety for Pediatric Anesthesia

Hot Topics in Safety for Pediatric Anesthesia

The timing of cognitive aid access during simulated pediatric intraoperative critical events

Severe outcomes of pediatric perioperative adverse events occurring in operating rooms compared to off‐site anesthetizing locations in the Wake Up Safe Database

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