Review of the 23rd Annual Meeting of the Society for Pediatric Anesthesia: Practice Improvement.

The 23rd Annual Meeting of the Society for Pediatric Anesthesia (SPA) held on October 16, 2009 in New Orleans attracted 270 attendees. Program chair Dr. Stephen Stayer and the education committee put together an exciting program with a focus on practice improvement. In the first session entitled “How to Improve Group Practice,” Dr. Sachin Kheterpal discussed the use of observational datasets including clinical registries such as the National Surgical Quality Improvement Program and clinical information systems as important mechanisms that may be used to answer research questions that cannot be answered using a randomized clinical trial. He emphasized the importance of choosing the research question carefully, identifying a specific event to study, collecting granular detailed data that are easy to enter, and testing the data by “hand review.” Dr. Randall Wetzel discussed the virtual pediatric intensive care unit (PICU) and the collaboration with the National Association of Children's Hospitals and Related Institutions to provide a common information space for caregivers of critically ill children. In 2005, this project evolved into a not-for-profit limited liability company, Virtual PICU Systems, LLC. Eighty-eight ICUs including 10 international ICUs currently participate with >250,000 cases included in a database growing at the rate of >70,000 patients each year. In his presentation about anesthesia information management systems (AIMS), Dr. Mohamed Rehman noted the increasing use of AIMS in the United States. He emphasized the importance of setting up the data warehouse before setting up the anesthesia system and that AIMS was excellent for discrete data but not for text data. Future directions include combining AIMS data with genomics data. In discussing the use of the electronic medical record system to improve operational efficiency, Dr. Randall Brenn identified 3 common measures of operating room efficiency including first case start time, turnover time, and block utilization. Electronic systems can be used not only to track each of these measures but can also help determine the effectiveness of practice changes by tracking these variables over time. The second morning session focused on “Changing Physician Practice,” and the first speaker, Dr. Amr Abouleish, discussed staffing considerations for the operating room from an anesthesia perspective. He concluded with the realization that “medicine is a science and health care is a business.” The final speaker for the morning was Dr. Dean Kurth, who provided a comparative overview of the difference between privileging and credentialing. In addition, he focused on the topics of quality assessment and performance management and how each of these affects the anesthesia provider. In the afternoon session entitled “Safety as a Motivator for Practice Improvement,” Dr. Steven Tosone noted that what we do as pediatric anesthesiologists is accompanied by both great success and great responsibility, thus ongoing improvement of patient safety is a central focus of our professional goals. Dr. Steven K. Howard spoke on crew resource management and discussed how accident analyses in aviation found that the crashes were frequently the product of dysfunctional communication among the crew members. This work revealed that reducing risk takes practice, and this could be improved through simulation. The next speaker, Dr. Thomas Shaw, reiterated that communication is a leading cause of medical-related errors and stressed the need for a handoff system that provides responsibility and accountability. Through standardized handoffs, there is an opportunity to give information and ask questions in an uninterrupted manner that not only improves patient care but also incidentally leads to team building. Dr. Eugenie Heitmiller concluded this session by discussing checklists as a tool for error management that are the result of communication errors. Examples include the use of checklists in the ICU to reduce length of stay and bloodstream infections, thereby leading to a potentially significant reduction in hospital costs. The last session of the day focused on “Lessons Learned from Hurricane Katrina.” Dr. Charles Fox spoke on clearly defining the basic responsibilities of a hospital facing a natural disaster. He outlined the potential barriers to success that included inadequate communication, the need to house essential personnel only, and issues surrounding water and power supplies. Dr. Paul Sirbaugh, a pediatric emergency room physician, incorporated the lessons learned from Katrina into disaster preparedness and suggested how this information could be used in other crisis situations (e.g., H1N1). He outlined options for responses to large-scale illness that included basics on triage, personnel, and facility flexibility that provided a very practical approach for the audience who may face similar situations. Upcoming educational opportunities sponsored by the SPA include the Fundamentals of Pediatric Anesthesiology, a program designed for the generalist, to be held in conjunction with the Winter meeting in San Antonio on April 17 to 18, 2010. The Winter meeting will also feature an educational program by the Congenital Cardiac Anesthesia Society, a Pediatric Advanced Life Saving course, and advanced ultrasound-guided regional anesthesia workshops. Finally, SPA will hold a joint annual meeting with SPA of Australia and New Zealand to be held on October 15, 2010 before the American Society of Anesthesiologists meeting in San Diego, CA. Abstract submission for these meetings and additional information may be found on the SPA Web site at www.pedsanesthesia.org. Shobha Malviya, MD University of Michigan Ann Arbor, Michigan Cheryl K. Gooden, MD, FAAP Mount Sinai Medical Center New York, New York David M. Polaner, MD, FAAP University of Colorado Boulder, Colorado Allison Kinder Ross, MD Duke University Medical Center Durham, North Carolina [email protected]