August 1, 2008

Initiative aims to improve pediatric anesthesia safety

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Jayant Deshpande, M.D.

Initiative aims to improve pediatric anesthesia safety

Gaining a better understanding of the causes of adverse outcomes during anesthesia in children is the goal of a new initative at the Monroe Carell Jr. Children’s Hospital at Vanderbilt.

Jayant Deshpande, M.D., anesthesiologist-in-chief at Children's Hospital, is also president of the Society of Pediatric Anesthesia (SPA), a national organization dedicated to improved pediatric perioperative care.

In this role, Deshpande is overseeing “Wake Up Safe,” a quality improvement initiative to collect and probe causes of negative events during anesthesia in children. This is the first comprehensive study of its kind ever conducted in pediatric anesthesiology.

“This initiative is important because we need to understand how we can continuously improve care and make the anesthetic experience even safer,” Deshpande said. “The reality is that our patients are getting younger, case complexity is increasing and society has the expectation that no preventable harm be done.”

The Anesthesia Patient Safety Foundation (APSF) has awarded SPA a $60,000 start-up grant for the initiative. Matthew Weinger, M.D., director of Vanderbilt's Center for Perioperative Research in Quality, is the secretary for APSF and was instrumental in connecting the two groups.

“The APSF felt that this was the right approach at the right time to improve pediatric patient safety,” said Weinger. “Our experience with other registries suggests that sufficient power to understand the causes of adverse events requires a multi-institutional, rigorous, uniform approach to data collection and analysis. Having the most prestigious children's' hospitals, including Vanderbilt, collaborate closely on this project, under the umbrella of SPA, is a recipe for success.”

SPA is developing a standardized process to assess serious perioperative adverse events. Data analysis will then allow the Wake Up Safe steering group to make recommendations for practice changes to improve patient safety.

The goal is to have all 10 participating institutions submitting data by the end of 2008, with first recommendations issued by the first quarter of 2009.

Initially, events to be studied include death, cardiac arrest, serious bodily injury, unanticipated major escalation of care, surgery on the wrong patient or body part, fire, awareness under anesthesia and medication error resulting in serious injury. As the participating institutions and the Wake Up Safe steering committee gather experience, additional events will be added.

After the initial phase, the goal is to make the registry and resulting recommendations available to all children’s hospitals and pediatric anesthesia programs nationwide.