Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2022
ReviewQuality improvement in New Zealand Pediatric Anesthesia; national quality direction, patient experience, equity, and collaboration.
The current priorities of the quality and safety of patient care in New Zealand at a central government level are described, with a focus on equity and patient experience. Priorities between stakeholders differ. We report the current quality activities of New Zealand pediatric anesthetists in relation to these governance aims, seeking gaps and suggesting future directions to align governance priorities and local activities. ⋯ Risk identification and critical event review contribute to local learnings in departments and institutions, and more widely to national and binational (with Australia) learnings. Several collaborative projects in Australia and New Zealand, whilst not primarily quality improvement projects, may improve pediatric anesthesia. These collaborations include a pediatric anesthesia professional network, a curriculum for a pediatric anesthetic fellowship, contributions to a document on standards for pediatric anesthesia, and a national quality group researching key performance indicators across New Zealand.
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Paediatric anaesthesia · Nov 2022
ReviewMaking quality improvement data more accessible and understandable: analyst, designer, and storyteller.
Making data more accessible and understandable in quality improvement requires a diversity of approaches beyond formal teaching in technical skills of measurement. Improvement practitioners might co-opt the wider skillset of analyst, designer, and storyteller in tailoring the team strategy needed to make best use of the data used to inform decision-making at the point of care. Data literacy levels, negative prior experiences, or limited access to technology might influence the ability of teams to engage in measurement. ⋯ Thoughtful data visualization takes account of the inherent perceptual challenges of comprehending data and complex images. Establishing a routine of simplification-removing redundant elements and distractions-and amplifying aspects that aid understanding can bring clarity to the important concepts within a chart. Story-telling techniques can help wider audiences engage with data by carefully shaping analytical and emotional content around a central narrative-always mindful of the limitations of working memory, and the emotional momentum needed to inspire change.
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Paediatric anaesthesia · Nov 2022
Editorial ReviewUsing Kotter's 8 Steps of Change to Tackle Over-fasting of children attending day surgery.
Over-fasting before surgery can lead to dehydration, irritability, lethargy, nausea, hypoglycemia, tricky intravenous cannulation, and decreased patient satisfaction (Newton et al., Pediatr Anesth, 2017, 27, 793). We used "Kotter's 8 steps for change" as an approach to tackling the problem of over-fasting in our day surgery unit (Kotter, Leading Change, Harvard Business School Press, 1996). Using a video of a patient's experience with overfasting, we created a sense of urgency and need for change (Step1: create urgency). ⋯ Our change ideas were divided into "short-term wins," "intermediate term goals," and "longer term goals." We focussed on creating short-term wins (Step6: create quick wins) and celebrated successes along the way to create initial momentum. We did this in parallel with working on longer term changes. We continued to work on cementing these new ideas (Step7: build on the changes), so that transformation in the day surgery would persist before using the same system to spread the change to the rest of the hospital (Step8: making it stick).
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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
Training Clinicians to become Leaders of Complex Change: Lessons from Scotland.
Clinicians are trained to diagnose disease and recommend treatments or procedures. This is the focus of much of undergraduate training, but delivery of healthcare depends on so much more than theoretical knowledge and technical skill. It is a complex environment where professionals from different backgrounds have to work together to deliver safe pathways of care to patients who have very varied backgrounds. ⋯ In turn, this can negatively impact on the experience of patients and staff. Attempting to change this complex environment requires a unique set of skills. This article describes an international fellowship that creates a network of individuals skilled in quality improvement, human factors, service design and leadership.