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National Pediatric Anesthesia Safety Quality Improvement Program in the United States

Kurth, C. Dean MD*; Tyler, Don MD; Heitmiller, Eugenie MD, FAAP; Tosone, Steven R. MD§; Martin, Lynn MD, MBA; Deshpande, Jayant K. MD, MPH

doi: 10.1213/ANE.0000000000000040
Pediatric Anesthesiology: Research Report

BACKGROUND: As pediatric anesthesia has become safer over the years, it is difficult to quantify these safety advances at any 1 institution. Safety analytics (SA) and quality improvement (QI) are used to study and achieve high levels of safety in nonhealth care industries. We describe the development of a multiinstitutional program in the United States, known as Wake-Up Safe (WUS), to determine the rate of serious adverse events (SAE) in pediatric anesthesia and to apply SA and QI in the pediatric anesthesia departments to decrease the SAE rate.

METHODS: QI was used to design and implement WUS in 2008. The key drivers in the design were an organizational structure; an information system for the SAE; SA to characterize the SAE; QI to imbed high-reliability care; communications to disseminate the learnings; and engaged leadership in each department. Interventions for the key drivers, included Participation Agreements, Patient Safety Organization designation, IRB approval, Data Management Co., membership fee, SAE standard templates, SA and QI workshops, and department leadership meetings.

RESULTS: WUS has 19 institutions, 39 member anesthesiologists, 734 SAE, and 736,365 anesthetics as of March, 2013. The initial members joined at year 1, and initial SAE were recorded by year 2. The SAE rate is 1.4 per 1000 anesthetics. Of SAE, respiratory was most common, followed by cardiac arrest, care escalation, and cardiovascular, collectively 76% of SAE. In care escalation, medication errors and equipment dysfunction were 89%. Of member anesthesiologists, 70% were trained in SA and QI by March 2013; virtually, none had SA and QI expertise before joining WUS.

CONCLUSION: WUS documented the incidence and types of SAE nationally in pediatric anesthesiology. Education and application of QI and SA in anesthesia departments are key strategies to improve perioperative safety by WUS.

Published ahead of print January 9, 2014

From the *Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland; §Department of Anesthesiology and Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Department of Anesthesiology & Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington; and Department of Anesthesiology, Arkansas Children’s Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Accepted for publication October 8, 2013.

Published ahead of print January 9, 2014

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to C. Dean Kurth, MD, Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, OH 45229. Address e-mail to

© 2014 International Anesthesia Research Society