Improving Outcomes through Implementation of an Infant Spinal Anesthesia Program for Urologic Surgery Patients

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Healthcare Quality Improvement

Background:

• Spinal anesthesia is a safe and effective alternative to general anesthesia in infants.
• Its use as a primary anesthetic in infants was historically limited at the institution.
• A healthcare improvement initiative was launched to increase its utilization.

Purpose of the Study:

• To increase the percentage of successful spinal anesthesia placements as the primary anesthetic in infants undergoing circumcision, open orchidopexy, or hernia repair.
• To achieve a target of 50% successful spinal placements by December 31, 2019, and sustain this rate.
• To improve anesthetic outcomes for pediatric surgical procedures.

Main Methods:

• An interdisciplinary team developed a key driver diagram and implemented interventions.
• Interventions included staff and family education, specialized anesthesiologist training, and process optimization.
• Data were collected retrospectively from electronic medical records and analyzed using statistical process control charts.

Main Results:

• A total of 470 infants (235 preintervention, 235 postintervention) were included in the study.
• Successful spinal anesthesia placement increased significantly from 11% to 45% (P < 0.0001) postintervention.
• The target rate of 50% was not fully achieved but showed substantial improvement.

Conclusions:

• The quality improvement project successfully enhanced the use of spinal anesthesia in infants for specific surgical procedures.
• The interventions led to a statistically significant increase in successful spinal anesthesia placements.
• This demonstrates the effectiveness of targeted quality improvement strategies in pediatric anesthesiology.