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Published on: January 17, 2011
Interventions guided by analysis of quality indicators decrease the frequency of laryngospasm during pediatric
1Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada. conor.mcdonnell@sickkids.ca
Insights
Quality improvement methods significantly reduced difficult-to-treat laryngospasm in pediatric anesthesia, decreasing calls for help by 50%. This enhanced patient safety and care quality.
Area of Science:
- Anesthesiology
- Quality Improvement Science
- Pediatric Patient Safety
Background:
- Pediatric anesthesia outcomes have improved, but unexpected laryngospasm remains a concern.
- Laryngospasm can cause patient morbidity and increased healthcare costs.
- Incidence rates vary widely, with some studies suggesting it's a frequent complication.
Purpose of the Study:
- To identify causes of unanticipated events in pediatric anesthesia.
- To decrease the incidence of laryngospasm using quality improvement (QI) methods.
- To improve patient safety through focused interventions and education.
Main Methods:
- A 30-month prospective study analyzing unanticipated events during pediatric anesthesia.
- Baseline data collected for 12 months to identify leading causes of complications.
- Interventions focused on awareness, education, and knowledge translation regarding laryngospasm.
Main Results:
- Laryngospasm accounted for 50% of 'calls for help' during the baseline period (0.25% incidence).
- Following interventions, laryngospasm represented 24% of 'calls for help' (0.09% incidence).
- A 50% reduction in the incidence of laryngospasm requiring intervention was achieved and sustained.
Conclusions:
- QI methodology effectively identified areas for improving pediatric anesthesia care.
- Targeted interventions for laryngospasm significantly reduced its incidence.
- The study demonstrated sustained improvement in patient safety and care quality.
Introduction:
Clinical outcomes in pediatric anesthesia have improved significantly over the last 20-30 years but unexpected laryngospasm that is difficult to treat can still result in patient morbidity, increased postoperative medical management and unnecessary hospital admission. The incidence of laryngospasm in pediatric anesthesia is difficult to determine with incidences from 0.9% to as high as 14% quoted in the literature. Clinical experience in our institution suggests that laryngospasm is one of the more frequent unanticipated complications that occur under general anesthesia. Therefore, we applied quality improvement (QI) methodology to: (i) identify the etiology and contributing factors that lead to unanticipated incidents during pediatric anesthesia care; and (ii) decrease the incidence of laryngospasm during pediatric anesthesia care by focusing on awareness, preparedness, education and knowledge translation.
Materials & Methods:
We conducted a 30-month improvement project. Twelve months of baseline data describing unanticipated events during pediatric anesthesia care were collected prospectively in a single institution. Data were analyzed to identify leading causes of these unanticipated events and to identify key drivers to improve overall quality of care. Interventions focused on raising awareness of the impact of laryngospasm on quality of patient care, knowledge dissemination and the creation of a knowledge translation tool to encourage future early learning. The primary objective was to decrease the incidence of unanticipated calls for help due to laryngospasm by 50% over a 12-month period.
Results:
During the 12-month baseline data period, laryngospasm was responsible for 33 instances (50%) of the 65 'calls for help' identified. The incidence of laryngospasm for which help was sought was 0.25% of all anesthetics performed during the baseline data period. After the introduction of our interventions, 16 (24%) of the 68 'calls for help' over the subsequent 16 months were attributed to laryngospasm. The incidence of laryngospasm for which help was sought during the second time period was 0.09% of all anesthetics performed.
Conclusions:
We applied QI methodology to identify potential improvements in the quality of anesthesia care we deliver to our patients. By designing a number of key drivers and interventions specifically focused on laryngospasm, we decreased the incidence of unanticipated calls for help due to laryngospasm by 50% and maintained this improvement to clinical care across a 12-month period.
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