Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital and the Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Nationwide Children's Hospital, Center for Clinical Excellence, Columbus, Ohio, USA.
Paediatr Anaesth. 2022 Aug;32(8):892-898. doi: 10.1111/pan.14474. Epub 2022 May 5.
Anesthesiology is a medical specialty well known for its work in patient safety, allowing the field to show a dramatic decrease in perioperative morbidity and mortality in both adults and children since the 1950s. Currently, anesthesia-related mortality is close to zero in healthy children, with deaths occurring primarily in children ASA physical status ≥4. Survival during anesthesia today represents the expectation and standard of care, rather than a marker of quality. Several programs and organizations have created measures to assess safety in pediatric anesthesia-yet none are universally accepted as safety metrics or bundled to evaluate specific aspects of care. In addition, collection of this nonstandardized data in individual centers requires a significant investment of resources and personnel limiting access to only large, "resource-rich" institutions. In this perspective paper, we provide an overview of the efforts made to enhance quality of care across medical specialties with a specific emphasis on pediatric anesthesiology. We discuss the need for standardization of metrics to establish targets and benchmarks for the delivery of high-quality care to children and adolescents mainly in North America. The time has come to move beyond mortality and establish universally accepted minimum outcome standards in pediatric anesthesia. We believe this will ultimately improve confidence in the quality of pediatric anesthesia care offered to children, no matter where they are receiving that care.
麻醉学是一个以患者安全为主要工作内容的医学专业，自 20 世纪 50 年代以来，该领域显著降低了成人和儿童围手术期发病率和死亡率。目前，健康儿童的麻醉相关死亡率接近零，死亡主要发生在 ASA 身体状况≥4 的儿童中。如今，儿童在麻醉下的生存是护理的期望和标准，而不是质量的标志。有几个项目和组织已经制定了评估小儿麻醉安全性的措施，但没有一个被普遍接受为安全指标，也没有将其捆绑起来评估护理的具体方面。此外，在各个中心收集这些非标准化数据需要大量的资源和人员投入，这使得只有大型的“资源丰富”机构才能获得这些数据。在这篇观点文章中，我们概述了为提高各个医学专业的医疗质量所做的努力，特别强调了小儿麻醉学。我们讨论了标准化指标的必要性，以确定为儿童和青少年提供高质量护理的目标和基准，主要是在北美地区。现在是时候超越死亡率，在小儿麻醉中建立普遍接受的最低结果标准了。我们相信，这最终将提高人们对为儿童提供的小儿麻醉护理质量的信心，无论他们在哪里接受护理。
