Global quality improvement programs and WakeUp Safe®
Jayant K. Deshpande MD and Faye Evans MD
Before reading today’s PAAD, I’d like to once again take the opportunity of reminding all of you to consider donating to LIFEBOX (https://www.lifebox.org/). Lifebox is a global nonprofit making surgery and anesthesia safer worldwide. Through tools, training, and partnerships their goal is to make surgery and anesthesia safer for every patient, every time. Myron Yaster MD
Editorial
Politis GD, Drum ET, Habre W, Bosenberg AT. Global quality improvement programs: One size doesn't fit all. Paediatr Anaesth. 2024 Sep;34(9):824-826. doi: 10.1111/pan.14950. Epub 2024 Jun 27. PMID: 38935579.
Educational Review
Iyer RS, Dave N, Du T, Bong CL, Siow YN, Taylor E, Tjia I. Wake Up Safe in the USA & International Patient Safety. Paediatr Anaesth. 2024 Sep;34(9):958-969. doi: 10.1111/pan.14920. Epub 2024 May 29. PMID: 38808685.
The recent issue of Pediatric Anesthesia includes an excellent editorial review article describing and comparing perioperative patient safety activities in several countries. Iyer and colleagues summarize the work of WakeUp Safe® (WUS) in the USA, as well as the national safety collaborations that are evolving in India, Australia/New Zealand, and Singapore. The paper describes “the distinct approaches within each country but also underscores the collective commitment to advancing patient safety, fostering international cooperation, and driving continuous improvement in healthcare practices across borders.” Such strides are leading to a significant reduction in perioperative harm in these countries. In the US alone, pediatric outcomes have improved from more than 10 per 10,000 in the 1950s to less than 1 per 10,000.1 As discussed in the August 26,2024 PAAD (https://ronlitman.substack.com/p/qiits-all-about-easy-access-to-the ), it’s all about the data and that “without data we can’t know [how we compare to our colleagues] and if we don’t know we can’t improve the quality and safety of our individual and group practices.” This becomes a bigger challenge when we deal with what we think are “rare” events or events that “I’ve never seen before”. Safety and improvement collaboratives allow us to gather and analyze such adverse events of interest with the goal of reducing such events in the future in our own practice and helping others do the same in theirs. Once we understand what we may be able to prevent or reduce harm, we need to know how apply this information to make changes in our clinical practice. In today’s PAAD, Iyer et al.2 highlight Wake Up Safe (WUS) educational sessions focused on quality improvement (QI) methods and analytics that provide the tools to continually improve care practices, customized to local needs and circumstances. The review by Iyer et al. describes current effective collaborations in high-income and middle countries.
However, the editorial by Politis et al.3 reminds us that there are many challenges to improving care in low-income countries (LICs), often because of shortages in Staff, Stuff, Space, Systems, and/or Social Support (5S’s) and encourages Wake Up Safe to establish effective collaborations in LICs. The editorial points out that “anesthesia-related mortality rates in those countries can approach 1 per 100.” To reduce peri-anesthesia harm to children in LICs, Politis and colleagues remind us that “one size doesn't fit all. They [WUS] will have to [must] tailor their programs to fit local problems, organizational frameworks, and resources.”
The WUS QI tools are based on the IHI (Institute for Healthcare Improvement) Model for Improvement and are meant to be tailored to local circumstances and local aims for improvement. The WUS workshop format allows participants to apply these tools to design their own improvement projects. Politis et al go on to state, “WUS is an extraordinary organization that has moved the patient safety needle in the United States, in other HICs, and in urban areas of MICs, and we hope they will do the same for LICs.”
We are delighted to report that WUS is working with SPA Global and organizations like the College of Anaesthesiologists of East, Central and Southern Africa (CANECSA) and Operation Smile to establish effective collaborations aimed at QI education of anesthesia providers and trainees, as well as on specific QI projects.
If you are interested in learning more about these opportunities, contact Jay Deshpande, Faye Evans, George Politis, the African Perioperative Research Group (APORG), or the Society for Pediatric Anesthesia’s Global Committee (Chair Mathew Kynes).
Send your thoughts and comments to Myron who will post in a Friday Reader Response
References
1. de Graaff JC, Johansen MF, Hensgens M, Engelhardt T. Best practice & research clinical anesthesiology: Safety and quality in perioperative anesthesia care. Update on safety in pediatric anesthesia. Best practice & research Clinical anaesthesiology 2021;35(1):27-39. (In eng). DOI: 10.1016/j.bpa.2020.12.007.
2. Iyer RS, Dave N, Du T, et al. Wake Up Safe in the USA & International Patient Safety. Paediatric anaesthesia 2024;34(9):958-969. (In eng). DOI: 10.1111/pan.14920.
3. Politis GD, Drum ET, Habre W, Bosenberg AT. Global quality improvement programs: One size doesn't fit all. Paediatric anaesthesia 2024;34(9):824-826. (In eng). DOI: 10.1111/pan.14950.