Wake Up Safe in the USA & International Patient Safety.

Patient safety is the most important aspect of anesthetic care. For both healthcare professionals and patients, the ideal would be no significant morbidity or mortality under anesthesia. Lessons from harm during healthcare can be shared to reduce harm and to increase safety. Many nations and individual institutions have developed robust safety systems to improve the quality and safety of patient care. Large registries that collect rare events, analyze them, and share findings have been developed. The approach, the funding, the included population, support from institutions and government and the methods of each vary. Wake Up Safe (WUS) is a patient safety organization accredited by Agency for Healthcare Research and Quality. Wake Up Safe was established in the United States in 2008 by the Society for Pediatric Anesthesia. The initiative aims to gather data on adverse events, analyze these incidents to gain insights, and apply this knowledge to ultimately reduce their occurrence. The purpose of this review is to describe the patient safety approaches in the USA. Through a national patient safety database WUS. Similar approaches either through WUS international or independent safety approaches have been described in Australia-New Zealand, India, and Singapore. We examine the patient safety processes across the four countries, evaluating their incident review process and the distribution of acquired knowledge. Our focus is on assessing the potential benefits of a WUS collaboration, identifying existing barriers, and determining how such a collaboration would integrate with current incident review databases or systems.

Development of local guidelines to prevent perioperative hypothermia in children: a prospective observational cohort study.

PURPOSE: Perioperative hypothermia (PH) is defined as core body temperature < 36°C during the perioperative period. The incidence of PH is not well established in children because of variations in perioperative temperature monitoring and control measures. We sought to 1) establish the incidence of pediatric PH, 2) assess its adverse outcomes, and 3) identify risk factors in our pediatric population to develop local guidelines for prevention of PH. METHODS: We conducted a prospective observational cohort study at a single tertiary hospital (KK Women's and Children's Hospital, Singapore) from June 2017 to December 2017 based on existing institutional practice. We recruited patients aged ≤ 16 yr undergoing surgery and determined the incidence and adverse outcomes of hypothermia. We identified risk factors for PH using univariate and multiple logistic regression analysis and used these to develop local guidelines. RESULTS: Of 1,766 patients analyzed, 213 (12.1%; 95% confidence interval, 10.6 to 13.7) developed PH. Among these cases of PH, only 4.5% would have been detected by a single measurement in the postanesthesia care unit (PACU). Adverse outcomes included a longer stay in the PACU (47 vs 39 min; P < 0.01), a higher incidence of shivering (7.1 vs 2.6%; P = 0.01), and more discomfort (3.8 vs 1.4%; P = 0.02) compared with normothermic patients. Risk factors for PH included preoperative temperature < 36°C, surgery duration > 60 min, ambient operating room temperature < 23.0°C, and several "high-risk" surgeries. Guidelines were developed based on these risk factors and customized according to clinical and workflow considerations. CONCLUSIONS: Perioperative hypothermia was a common problem in our pediatric population and was associated with significant adverse outcomes. Guidelines developed based on risk factors identified in the local context can facilitate workflow and implementation within the institution.

RéSUMé: OBJECTIF: L'hypothermie périopératoire (HP) est définie par une température corporelle centrale < 36 °C pendant la période périopératoire. L'incidence de l'HP chez les enfants n'est pas connue avec précision en raison des variations dans le suivi de la température périopératoire et des mesures de contrôle. Nous avons cherché à (1) déterminer l'incidence de l'HP pédiatrique, (2) évaluer ses effets préjudiciables et (3) identifier les facteurs de risque dans notre population pédiatrique afin d'élaborer des lignes directrices locales pour la prévention de l'HP. MéTHODES: Nous avons mené une étude de cohorte observationnelle prospective dans un seul hôpital de niveau tertiaire (KK Women's and Children's Hospital, Singapour) de juin 2017 à décembre 2017 sur la base des pratiques existantes dans l'établissement. Nous avons recruté des patients âgés de 16 ans ou moins subissant une intervention chirurgicale et nous avons déterminé l'incidence et les effets secondaires de l'hypothermie. Nous avons identifié les facteurs de risque de l'HP en utilisant des analyses de régression logistique monofactorielle et multifactorielle qui nous ont servi à élaborer ces lignes directrices locales. RéSULTATS: Parmi les 1 766 cas de patients analysés, 213 (12,1 %; intervalle de confiance à 95 % : 10,6 à 13,7) ont développé une HP. Parmi ceux-ci, seulement 4,5 % auraient été détectés par une mesure unique dans l'unité de soins post anesthésie (salle de réveil). Les événements indésirables ont inclus un séjour plus long en salle de réveil (47 contre 39 minutes; P < 0,01), une plus grande incidence de tremblements (7,1 % contre 2,6 %; P = 0,01) et plus d'inconfort (3,8 % contre 1,4 %; P = 0,02), comparativement aux patients normothermiques. Les facteurs de risque d'HP étaient, notamment, une température préopératoire < 36 °C, la durée de la chirurgie > 60 min, la température de la salle d'opération < 23,0°C et plusieurs chirurgies à « risque élevé ¼. Des lignes directrices ont été élaborées à partir de ces facteurs de risque et adaptées en tenant compte de considérations cliniques et des flux de travail. CONCLUSIONS: L'hypothermie périopératoire était un problème fréquent dans notre population pédiatrique et a été associée à des effets secondaires significatifs. Des lignes directrices élaborées en fonction de facteurs de risque dans un contexte local peuvent faciliter le flux de travail et leur mise en œuvre au sein d'un établissement.

Use of an Offsite Intraoperative MRI Operating Theater for Pediatric Brain Tumor Surgery: Experience from a Singapore Children's Hospital.

BACKGROUND: Intraoperative magnetic resonance imaging (iMRI) has been recognized as a useful adjunct for brain tumor surgery in pediatric patients. There is minimal data on the use of an offsite intraoperative magnetic resonance imaging operating theater (iMRI OT), whereby vehicle transfer of patients is involved. The primary aim of this study is to validate the feasibility of perioperative patient transfer to use an offsite iMRI OT for patients with pediatric brain tumor. Secondary objectives include the assessment of tumor resection efficacy and perioperative outcomes in our patient cohort. METHODS: This is a retrospective, single-institution clinical study of prospectively collected data from Singapore's largest children hospital. Variables of interest include issues encountered during interhospital transfer, achievement of surgical aims, length of stay in hospital, and postoperative complications. Our findings were compared with results of related studies published in the literature. RESULTS: From January 1, 2009 to December 31, 2018, a total of 35 pediatric operative cases were performed in our offsite iMRI OT. Within this cohort, 24 of these were brain tumor surgery cases. For all the patients in this study, use of the iMRI OT influenced intraoperative decisions. Average ambulance transport time from parent hospital to the iMRI OT was 30.5 minutes, and from iMRI OT back to the parent hospital after surgery was 27.7 minutes. The average length of hospitalization stay was 7.9 days per patient. There were no ferromagnetic accidents during perioperative iMRI scanning and no airway/hemodynamic incidents in patients encountered during interhospital transfer. CONCLUSIONS: In our local context, the use of interhospital transfers for access to iMRI OT is a safe and feasible option in ensuring good patient outcomes for a select group of patients with pediatric brain tumors.

Audits and critical incident reporting in paediatric anaesthesia: lessons from 75,331 anaesthetics.

INTRODUCTION: This study reports our experience of audit and critical incidents observed by paediatric anaesthetics from 2000 to 2010 at a paediatric teaching hospital in Singapore. METHODS: Data pertaining to patient demographics, practices and critical incidents during anaesthesia and in the perioperative period were prospectively collected via an audit form and retrospectively analysed thereafter. RESULTS: A total of 2,519 incidents were noted at the 75,331 anaesthetics performed during the study period. There were nine deaths reported. The majority of incidents reported were respiratory critical incidents (n = 1,757, 69.8%), followed by cardiovascular incidents (n = 238, 9.5%). Risk factors for critical incidents included age less than one year, and preterm and former preterm children. CONCLUSION: Critical incident reporting has value, as it provides insights into the system and helps to identify active and system errors, thus enabling the formulation of effective preventive strategies. By creating and maintaining an environment that encourages reporting, we have maintained a high and consistent reporting rate through the years. The teaching of analysis of critical incidents should be regarded by all clinicians as an important tool for improving patient safety.