Paediatric anaesthesia
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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
Video observation of anesthesia practice: a useful and reliable tool for quality improvement initiatives.
Patients with central venous catheters who are transferred out of the Intensive Care Unit to the care of an anesthesiology team for an operation or interventional radiology procedure had excessive rates of catheter associated blood stream infection (CABSI). ⋯ Although video recording has been used to evaluate adherence to resuscitation protocols in both trauma and in neonatal resuscitation, (Pediatric Emergency Care, 26, 2010, 803; Pediatrics, 117, 2006, 658; Pediatrics, 106, 2000, 654) we believe this is the first time that video has been used to record before and after behaviors for an anesthesia quality improvement initiative.
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Paediatric anaesthesia · Jul 2013
Modification of anesthesia practice reduces catheter-associated bloodstream infections: a quality improvement initiative.
A major strategic hospital goal is the prevention of catheter associated bloodstream infections (CABSI). In 2009, at our institution, the CABSI rate for patients who traveled out of the ICU to the operating room and other procedural areas under the care of an anesthesiologist was increased compared to patients who remained on the unit. ⋯ Practice modification by anesthesiology providers in the operating room can decrease workspace contamination and is associated with decreased CABSI rates.
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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).