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Wake Up Safe and Root Cause Analysis: Quality Improvement in Pediatric Anesthesia

Tjia, Imelda MD*; Rampersad, Sally MB, FRCA†‡; Varughese, Anna MD, MPH§; Heitmiller, Eugenie MD, FAAP; Tyler, Donald C. MD, MBA#; Lee, Angela C. MD**††; Hastings, Laura A. MD‡‡; Uejima, Tetsu MD, MMM, CPHRM§§

doi: 10.1213/ANE.0000000000000266
Pediatric Anesthesiology: Special Article

In 2006, the Quality and Safety Committee of the Society for Pediatric Anesthesia initiated a quality improvement project for the specialty of pediatric anesthesiology that ultimately resulted in the development of Wake Up Safe (WUS), a patient safety organization that maintains a registry of de-identified, serious adverse events. The ultimate goal of WUS is to implement change in processes of care that improve the quality and safety of anesthetic care provided to pediatric patients nationwide. Member institutions of WUS submit data regarding the types and numbers of anesthetics performed and information pertaining to serious adverse events. Before a member institution submits data for any serious adverse event, 3 anesthesiologists who were not involved in the event must analyze the event with a root cause analysis (RCA) to identify the causal factor(s). Because institutions across the country use many different RCA methods, WUS educated its members on RCA methods in an effort to standardize the analysis and evaluate each serious adverse event that is submitted. In this review, we summarize the background and development of this patient safety initiative, describe the standardized RCA method used by its members, demonstrate the use of this RCA method to analyze a serious event that was reported, and discuss the ways WUS plans to use the data to promote safer anesthetic practices for children.

From the *Department of Pediatric Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas; Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital; Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington; §Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center; Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Anesthesiology and Critical Care Medicine and Pediatrics, Division of Pediatric Anesthesia, Johns Hopkins School of Medicine, Baltimore, Maryland; #Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; **Division of Anesthesiology, Sedation and Perioperative Medicine, Children’s National Medical Center, Washington, DC; ‡‡Department of Anesthesiology, Keck School of Medicine, Children’s Hospital Los Angeles, Los Angeles, California; and §§Department of Pediatric Anesthesia, Ann and Robert Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois.

Accepted for publication March 12, 2014.

Funding: No funding.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Imelda Tjia, MD, Department of Pediatric Anesthesiology, Texas Children’s Hospital, 6621 Fannin St., Suite A300, Houston, TX 77030. Address e-mail to

© 2014 International Anesthesia Research Society