Related Experiment Videos
Perspectives in Pediatric Ambulatory Anesthesia: Part 2-One Center's 15 Year Experience Improving Quality and Safety
Jennifer L Chiem1, Elizabeth E Hansen1, Kayla Reece2
1Department of Anesthesiology & Pain Medicine, Seattle Children's/University of Washington School of Medicine, Seattle, Washington, USA.
Insights
This study shows that a learning healthcare system (LHS) approach in pediatric ambulatory surgery centers significantly boosts quality improvement project completion. Implementing this model, with engaged leadership and accessible data, enhances healthcare outcomes and sustainability.
Area of Science:
- Healthcare Management
- Quality Improvement Science
- Pediatric Surgery
Background:
- Pediatric ambulatory surgery is the dominant surgical care model in the US, influenced by economic factors.
- Variability exists in practice patterns, quality improvement (QI) cycles, and outcomes across regions.
- Opportunities remain to address knowledge gaps and establish sustainable QI pathways.
Purpose of the Study:
- To describe the evolution of a single pediatric ambulatory surgery center's QI practice.
- To demonstrate the impact of a learning healthcare system (LHS) on QI processes and outcomes.
- To provide a perspective on overcoming challenges in pediatric ambulatory surgical care.
Main Methods:
- Retrospective review of QI process, outcome, and balancing metrics from an electronic health record (EHR) at a pediatric ambulatory surgery center (ASC) from July 2010 to December 2024.
- Utilized commercial software to extract de-identified, aggregated health data from the EHR.
- Employed statistical process control charts to differentiate between common cause and special cause variation in QI metrics.
Main Results:
- QI themes included opioid-free anesthesia, enhanced recovery, environmental efforts, positive deviance, and LHS principles.
- Demonstrated improvements across all six domains of quality: effectiveness, efficiency, timeliness, patient experience, equity, and safety.
- Achieved a 13-fold increase in QI project completion rate through self-serve, real-world data access, enabling more ambitious QI tasks.
Conclusions:
- The described LHS methods show potential generalizability for improving pediatric ambulatory surgical care.
- Key requirements include engaged leadership, a standardized QI framework, and accessible real-world EHR data.
- Fostering a culture of teamwork, change, and continuous improvement is crucial for successful implementation and sustainability.
Introduction:
Pediatric ambulatory surgery has become the dominant model of surgical care in the United States, driven primarily by economic forces. There is variability in regional practice patterns, quality improvement cycles, and outcomes. Opportunity exists to overcome knowledge gaps and provide sustainable pathways of quality improvement. Our unique capability of describing the evolution of our pediatric ambulatory quality improvement practice allows us to contribute a single center's perspective.
Methods:
We chose to complete a comprehensive retrospective review of our quality improvement process, outcome, and balancing metrics contained in our electronic health record (EHR) from our free-standing pediatric ambulatory surgery center (ASC) from July 2010 through December 2024. A commercial software system extracted de-identified, aggregated health data from the system's EHR. The data are processed and presented in statistical process control charts. This methodology allows clinicians to distinguish between common cause and special cause variation.
Results:
Improvement themes (opioid-free anesthesia and stewardship, enhanced recovery, environmental efforts, positive deviance, and learning healthcare system) are described. Improvements in all six domains of quality (effectiveness, efficiency/timeliness, patient experience, equity, and safety) are illustrated with reliable sustainability. Our system achieved approximately a 13-fold increase in quality improvement (QI) project completion rate with self-serve, real-world data access; enabling the team to take on improvement tasks previously deemed too big, lengthy, or risky to complete.
Discussion:
We provide preliminary evidence that these methods may be generalizable. Requirements include engaged leadership, a standard framework for improvement with experienced leadership or accessible support, and easy access to real-world electronic medical record data (i.e., learning healthcare system [LHS]). Lastly, leaders must create a culture supportive of teamwork, change, and continuous improvement. Systems facilitate adoption and hinder resistance to standards, always with implementation and sustainability in mind. Meaningful, large-scale improvements in healthcare outcomes require collaboration across LHSs.
Related Concept Videos
01:13Patient-centered Care
01:24General Anesthesia: Overview
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
01:24Parenteral Anesthetics: Overview
01:19Standards of Care II