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Quality and safety in pediatric anesthesia: how can guidelines, checklists, and initiatives improve the outcome?

Hagerman, Nancy S.; Varughese, Anna M.; Kurth, C. Dean

Current Opinion in Anesthesiology: June 2014 - Volume 27 - Issue 3 - p 323–329
doi: 10.1097/ACO.0000000000000078

Purpose of review Cognitive aids are tangible or intangible instruments that guide users in decision-making and in the completion of a complex series of tasks. Common examples include mnemonics, checklists, and algorithms. Cognitive aids constitute very effective approaches to achieve well tolerated, high quality healthcare because they promote highly reliable processes that reduce the likelihood of failure. This review describes recent advances in quality improvement for pediatric anesthesiology with emphasis on application of cognitive aids to impact patient safety and outcomes.

Recent findings Quality improvement encourages the examination of systems to create stable processes and ultimately high-value care. Quality improvement initiatives in pediatric anesthesiology have been shown to improve outcomes and the delivery of efficient and effective care at many institutions. The use of checklists, in particular, improves adherence to evidence-based care in crisis situations, decreases catheter-associated bloodstream infections, reduces blood product utilization, and improves communication during the patient handoff process. Use of this simple tool has been associated with decreased morbidity, fewer medical errors, improved provider satisfaction, and decreased mortality in nonanesthesia disciplines as well.

Summary Successful quality improvement initiatives utilize cognitive aids such as checklists and have been shown to optimize pediatric patient experience and anesthesia outcomes and reduce perioperative complications.

Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

Correspondence to Nancy S. Hagerman, MD, Department of Anesthesiology MLC 2001, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. Tel: +1 513 636 4408; e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.