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It's Not Over Till It's Over: A Prospective Cohort Study and Analysis of "Anesthesia Stat!" Emergency Calls in the
Susan R Vishneski1, Moeko Nagatsuka1, L D Smith1
1Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, USA.
Insights
Emergency "Anesthesia Stat!" calls in pediatric care, particularly in the post-anesthesia care unit (PACU), are often respiratory-related. Findings suggest continuous monitoring and skilled airway management are crucial for patient safety.
Area of Science:
- Pediatric Anesthesiology
- Patient Safety
- Healthcare Communication
Background:
- Emergency "Anesthesia Stat!" (AS!) calls are frequent in medical centers despite advanced communication systems.
- Analysis of post-procedure AS! calls can reveal insights to improve patient safety.
Purpose of the Study:
- To analyze the characteristics and causes of emergency "Anesthesia Stat!" calls in a pediatric setting.
- To identify trends and actionable insights for enhancing patient safety during the perioperative period.
Main Methods:
- Prospective data collection of "AS!" calls from April 2015 to May 2018 in pediatric operating rooms, off-site locations, and the post-anesthesia care unit (PACU).
- Data included demographics, location, timing, event duration, vital signs, medications, and staff involved.
- Narrative accounts of events were documented.
Main Results:
- A total of 82 "AS!" calls were recorded in pediatric patients (11 days to 17 years old).
- 60% of calls occurred during emergence, and 87% were respiratory-related.
- In the PACU, 97% of calls were respiratory, with 86% involving desaturation requiring intervention, often within 30 minutes of arrival.
Conclusions:
- Continuous availability of staff with advanced airway management skills is essential, especially in the PACU.
- Pediatric patients require a minimum of 30 minutes of monitoring post-arrival in the PACU following general anesthesia and surgery.
Abstract:
Background Emergency "Anesthesia Stat!" (AS!) calls remain a common practice in medical centers even when advanced communication infrastructures are available. We hypothesize that the analysis of post-procedure "AS!" calls will lead to actionable insights which may enhance patient safety. Methods After institutional review board approval, we prospectively collected data from April 2015 through May 2018 on "AS!" calls throughout the pediatric operating rooms (OR), off-site locations, and post-anesthesia care unit (PACU) at a tertiary university medical center. Data recorded included demographic information, location, time of the event, event duration, vital signs, medications, anesthesia staff, attending anesthesiologist, and staff responding to the call. A narrative account of the event was also documented. Results A total of 82 "AS!" calls occurred, with ages ranging from 11 days old to 17 years old. Forty-nine of the 82 calls (60%) occurred at emergence. Seventy-one of the 82 calls (87%) were solely respiratory-related. Thirty-five of 49 emergence calls (71%) occurred in the PACU. Further, 34 of 35 PACU calls (97%) were respiratory-related, with 30 of 35 PACU calls (86%) associated with desaturation requiring intervention by anesthesia staff. Finally, 31 of 35 PACU calls (89%) occurred within 30 minutes of patient arrival to PACU. Conclusion Analysis of "AS!" events from our PACU continues to support the need for the prompt and continuous availability of at least one staff member with advanced airway management skills. Further, pediatric patients undergoing general anesthesia and surgery should likely be monitored for a minimum of 30 minutes following arrival in the PACU.
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