title: Interventions guided by analysis of quality indicators decrease the frequency of laryngospasm during pediatric anesthesia.
abstract: BACKGROUND
  Clinical outcomes in pediatric anesthesia have improved significantly over the last 20-30 years but unexpected laryngospasm that is difficult to treat can still result in patient morbidity, increased postoperative medical management and unnecessary hospital admission. The incidence of laryngospasm in pediatric anesthesia is difficult to determine with incidences from 0.9% to as high as 14% quoted in the literature. Clinical experience in our institution suggests that laryngospasm is one of the more frequent unanticipated complications that occur under general anesthesia. Therefore, we applied quality improvement (QI) methodology to: (i) identify the etiology and contributing factors that lead to unanticipated incidents during pediatric anesthesia care; and (ii) decrease the incidence of laryngospasm during pediatric anesthesia care by focusing on awareness, preparedness, education and knowledge translation.
  
  
  METHODS
  We conducted a 30-month improvement project. Twelve months of baseline data describing unanticipated events during pediatric anesthesia care were collected prospectively in a single institution. Data were analyzed to identify leading causes of these unanticipated events and to identify key drivers to improve overall quality of care. Interventions focused on raising awareness of the impact of laryngospasm on quality of patient care, knowledge dissemination and the creation of a knowledge translation tool to encourage future early learning. The primary objective was to decrease the incidence of unanticipated calls for help due to laryngospasm by 50% over a 12-month period.
  
  
  RESULTS
  During the 12-month baseline data period, laryngospasm was responsible for 33 instances (50%) of the 65 'calls for help' identified. The incidence of laryngospasm for which help was sought was 0.25% of all anesthetics performed during the baseline data period. After the introduction of our interventions, 16 (24%) of the 68 'calls for help' over the subsequent 16 months were attributed to laryngospasm. The incidence of laryngospasm for which help was sought during the second time period was 0.09% of all anesthetics performed.
  
  
  CONCLUSIONS
  We applied QI methodology to identify potential improvements in the quality of anesthesia care we deliver to our patients. By designing a number of key drivers and interventions specifically focused on laryngospasm, we decreased the incidence of unanticipated calls for help due to laryngospasm by 50% and maintained this improvement to clinical care across a 12-month period.
authors.affiliation: Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada. conor.mcdonnell@sickkids.ca
authors.forename: Conor
authors.initials: C
authors.lastname: Mc Donnell
mesh_terms: D000758:Anesthesia / Q000009:adverse effects*; D002648:Child; D056902:Clinical Alarms; D003625:Data Collection; D003627:Data Interpretation, Statistical; D004630:Emergencies; D006801:Humans; D033181:Information Dissemination; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D007826:Laryngismus / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D012307:Risk Factors; D016896:Treatment Outcome