From little adults to pediatric patients: quality improvement in pediatric anesthesia

The concept of quality improvement (QI) embraces a systematic approach using specific techniques to improve quality. The objective of this non-systematic review article is to present one concept of QI in healthcare and its application in pediatric anesthesia. As can be shown, QI is well established in pediatric anesthesia. ‘Plan-Do-Study-Act’ cycles, an approach for improvement in health care in which one learns from taking action, are considered a feasible tool. Quality improvement models do not replace clinical research and scientific publishing, but promote the implementation of new findings into clinical practices.

Pediatric anesthesia; Quality improvement

[1] Mai CL, Coté CJ. A history of pediatric anesthesia: a tale of pioneers and equipment. Pediatric Anesthesia. 2012; 22: 511–520.

[2] Lyman HM. Artificial Anaesthesia and Anaesthetics. New York: William Wood and Company. 1881.

[3] Robson CH. Anesthesia in children. Anesthesia & Analgesia. 1925; 4: 235–240.

[4] Ayre P. Anaesthesia for hare-lip and cleft palate operations on babies. British Journal of Surgery. 1937; 131–132.

[5] Smith R. The pediatric anesthetist, 1950–1975. Anesthesiology. 1975; 43: 144–155.

[6] Varkey P, Reller MK, Resar RK. Basics of quality improvement in health care. Mayo Clinic Proceedings. 2007; 82: 735–739.

[7] Berwick DM. Continuous improvement as an ideal in health care. New England Journal of Medicine. 1989; 320: 53–56.

[8] Berwick DM, Nolan TW. Overview: cooperating for improvement. The Joint Commission Journal on Quality Improvement. 1995; 21: 573–577.

[9] Berwick DM. Developing and testing changes in delivery of care. Annals of Internal Medicine. 1998; 128: 651–656.

[10] Gregory KE. Differentiating between research and quality improvement. The Journal of Perinatal & Neonatal Nursing. 2015; 29: 100–102.

[11] Kurth CD. Introducing quality improvement. Paediatric Anaesthesia. 2013; 23: 569–570.

[12] Whitney G, Daves S, Hughes A, Watkins S, Woods M, Kreger M, et al. Implementation of a transfusion algorithm to reduce blood product utilization in pediatric cardiac surgery. Paediatric Anaesthesia. 2013; 23: 639–646.

[13] Rachman BR, Mink RB. A prospective observational quality improve-ment study of the sustained effects of a program to reduce unplanned extubations in a pediatric intensive care unit. Paediatric Anaesthesia. 2013; 23: 614–620.

[14] Kurth CD, Tyler D, Heitmiller E, Tosone SR, Martin L, Deshpande JK. National pediatric anesthesia safety quality improvement program in the United States. Anesthesia and Analgesia. 2014; 119: 112–121.

[15] Haché M, Sun LS, Gadi G, Busse J, Lee AC, Lorinc A, et al. Outcomes from wake up safe, the pediatric anesthesia quality improvement initiative. Pediatric Anesthesia. 2020; 30: 1348–1354.

[16] Christensen RE, Lee AC, Gowen MS, Rettiganti MR, Deshpande JK, Morray JP. Pediatric perioperative cardiac arrest, death in the off hours: a report from wake up safe, the pediatric quality improvement initiative. Anesthesia and Analgesia. 2018; 127: 472–477.

[17] Christensen RE, Nause-Osthoff RC, Waldman JC, Spratt DE, Hearn JWD. Adverse events in radiation oncology: a case series from wake up safe, the pediatric anesthesia quality improvement initiative. Paediatric Anaesthesia. 2019; 29: 265–270.

[18] Lobaugh LMY, Martin LD, Schleelein LE, Tyler DC, Litman RS. Medication errors in pediatric anesthesia: a report from the wake up safe quality improvement initiative. Anesthesia and Analgesia. 2017; 125: 936–942.

[19] Wakimoto M, Miller R, Kim SS, Uffman JC, NafiuS OO, Tobias JD, et al. Perioperative anaphylaxis in children: a report from the Wake‐Up Safe collaborative. Pediatric Anesthesia. 2021; 31: 205–212.

[20] Habre W, Disma N, Virag K, Becke K, Hansen TG, Jöhr M, et al. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. The Lancet Respiratory Medicine. 2017; 5: 412–425.

[21] Dadure C, Veyckemans F, Bringuier S, Habre W. Epidemiology of regional anesthesia in children: lessons learned from the European Multi‐Institutional Study APRICOT. Pediatric Anesthesia. 2019; 29: 1128–1135.

[22] Engelhardt T, Ayansina D, Bell GT, Oshan V, Rutherford JS, Morton NS. Incidence of severe critical events in paediatric anaesthesia in the United Kingdom: secondary analysis of the anaesthesia practice in children observational trial (APRICOT study). Anaesthesia. 2019; 74: 300–311.

[23] Engelhardt T, Virag K, Veyckemans F, Habre W. Airway management in paediatric anaesthesia in Europe-insights from APRICOT (Anaesthesia Practice in Children Observational Trial): a prospective multicentre observational study in 261 hospitals in Europe. British Journal of Anaesthesia. 2018; 121: 66–75.

[24] Habre W. Pediatric anesthesia after APRICOT (Anaesthesia PRactice in Children Observational Trial): who should do it? Current Opinion in Anaesthesiology. 2018; 31: 292–296.

[25] Hansen TG, Børke WB, Isohanni MH, Castellheim A. Incidence of severe critical events in paediatric anaesthesia in Scandinavia: secondary analysis of Anaesthesia PRactice in Children Observational Trial (APRICOT). Acta Anaesthesiologica Scandinavica. 2019; 63: 601–609.

[26] Michel F, Constant I. Critical events in paediatric anaesthesia: lessons learned from the APRICOT study’s French data. Anaesthesia Critical Care & Pain Medicine. 2019; 38: 599–600.

[27] Virag K, Sabourdin N, Thomas M, Veyckemans F, Habre W. Epidemi-ology and incidence of severe respiratory critical events in ear, nose and throat surgery in children in Europe: a prospective multicentre observational study. European Journal of Anaesthesiology. 2019; 36: 185–193.