First name
Blair
Last name
Kraus

Title

Quality improvement project to reduce pediatric clear liquid fasting times prior to anesthesia.

Year of Publication

2019

Number of Pages

698-704

Date Published

2019 07

ISSN Number

1460-9592

Abstract

<p><strong>BACKGROUND: </strong>Unnecessarily long preprocedural fasting can cause suffering and distress for children and their families. Institutional fasting policies are designed to consistently achieve minimum fasting times, often without regard to the extent to which actual fasting times exceed these minimums. Children at our hospital frequently experienced clear liquid fasting times far in excess of required minimums.</p>

<p><strong>AIMS: </strong>The aim of this study was to&nbsp;utilize quality improvement methodology to reduce excess fasting times, with a goal of achieving experienced clear liquid fasting times ≤4&nbsp;hours for 60% of our patients.</p>

<p><strong>METHODS: </strong>This quality improvement project was conducted between July 2017 and August 2018. A multidisciplinary team performed a series of Plan-Do-Study-Act cycles focused on children undergoing elective procedures at a large children's hospital. Key drivers for clear liquid fasting times and relevant balancing measures were identified. Data were analyzed using control charts and statistical process control methods.</p>

<p><strong>RESULTS: </strong>Approximately 16&nbsp;000 children were involved in this project. Over the course of the project, the percentage of children with goal clear liquid fasting times improved from the baseline of 20%-63%, with a change in the mean fasting time from 9&nbsp;hours to 6&nbsp;hours. There were no significant effects on balancing measures (case delays/cancellations and clinically significant aspiration events).</p>

<p><strong>CONCLUSION: </strong>Using quality improvement methodology, we safely improved the duration of preoperative fasting experienced by our patients. Our results provide additional data supporting the safety of more permissive 1-hour clear liquid fasting minimums. We suggest other institutions pursue similar efforts to improve patient and family experience.</p>

DOI

10.1111/pan.13661

Alternate Title

Paediatr Anaesth

PMID

31070840

Title

A Dedicated Pediatric Spine Deformity Team Significantly Reduces Surgical Time and Cost.

Year of Publication

2018

Number of Pages

1574-1580

Date Published

2018 Sep 19

ISSN Number

1535-1386

Abstract

<p><strong>BACKGROUND: </strong>As high-quality health care becomes increasingly expensive, improvement projects are focused on reducing cost and increasing value. To increase value by reducing operating room (OR) utilization, we studied the effect of a dedicated team approach for posterior spinal fusion (PSF) for scoliosis.</p>

<p><strong>METHODS: </strong>With institutional support, an interdisciplinary, dedicated team was assembled. Members developed standardized protocols for anesthetic management and patient transport, positioning, preparation, draping, imaging, and wake-up. These protocols were initially implemented with a small interdisciplinary team, including 1 surgeon (Phase 1), and then were expanded to include a second surgeon and additional anesthesiology staff (Phase 2). We compared procedures performed with a dedicated team (the Dedicated Team cases) and procedures performed without a such a team (the Casual Team cases). Because of the heterogeneous nature of PSF for scoliosis, we developed a case categorization system: Category 1 was relatively homogeneous and indicated patients with fusion of ≤12 levels, no osteotomies, and a body mass index (BMI) of &lt;25 kg/m, and Category 2 was more heterogeneous and indicated patients with fusion of &gt;12 levels and/or ≥1 osteotomy and/or a BMI of ≥25 kg/m.</p>

<p><strong>RESULTS: </strong>In total, 89 Casual Team and 78 Dedicated Team cases were evaluated: 71 were in Category 1 and 96 were in Category 2. Dedicated Team cases used significantly less OR time for both Categories 1 and 2 (p &lt; 0.001). In Category-1 cases, the average reduction was 111.4 minutes (29.7%); in Category-2 cases, it was 76.9 minutes (18.5%). The effect of the Dedicated Team was scalable: the reduction in OR time was significant in both Phase 1 and Phase 2 (p &lt; 0.001). The Dedicated Team cases had no complications. Cost reduction averaged approximately $8,900 for Category-1 and $6,000 for Category-2 cases.</p>

<p><strong>CONCLUSIONS: </strong>By creating a dedicated team and standardizing several aspects of PSFs for scoliosis, we achieved a large reduction in OR time. This increase in team efficiency was significant, consistent, and scalable. As a result, we can routinely complete 2 Category-1 PSFs in the same OR with the same team without exceeding standard block time.</p>

DOI

10.2106/JBJS.17.01584

Alternate Title

J Bone Joint Surg Am

PMID

30234621

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