Implementation of an electroencephalogram‐guided propofol anesthesia education program in an academic pediatric anesthesia practice

Abstract

Background Propofol total intravenous anesthesia (TIVA) is increasingly popular in pediatric anesthesia, but education on its use is variable and over‐dosage adverse events are not uncommon. Recent work suggests that electroencephalogram (EEG) parameters can guide propofol dosing in the pediatric population. This education quality improvement project aimed to implement a standardized EEG TIVA training program over 12 months in a large pediatric anesthesia division. Methods The division consisted of 63 faculty, 11 clinical fellows, 32 residents, and 28 nurse anesthetists at the Children's Hospital of Philadelphia. The program was assessed for effectiveness (a significant improvement in EEG knowledge scores), scalability (training 50% of fellows and staff), and sustainability (recurring EEG lectures for 80% of rotating residents and 100% of new fellows and staff). The key drivers included educational content development (lectures, articles, and hand‐outs), training a cohort of EEG TIVA trainers, intraoperative teaching (teaching points and dosing tables), decision support tools (algorithms and anesthesia electronic record pop‐ups), and knowledge tests (written exam and verbal quiz during cases). Results Over 12 months, 78.5% of the division (62/79) completed EEG training and test scores improved (mean score 38% before training vs 59% after training, p < .001). Didactic lectures were given to 100% of the fellows, 100% (11/11) of new staff, and 80% (4/5 blocks) of rotating residents. Conclusion This quality improvement education project successfully trained pediatric anesthesia faculty, staff, residents, and fellows in EEG‐guided TIVA. The training program was effective, scalable, and sustainable over time for newly hired faculty staff and rotating fellows and residents.

Worldwide journey in pediatric anesthesia quality and safety

“…That themed issue described the initial application of these sciences to improving the quality of pediatric anesthesia care. As evident in the current issue, these sciences have been adopted widely by departments in Europe, Asia, and North America with evidence of improved quality 3–13 . Also evident is the variability in pediatric anesthesia quality across the world, noted by the lack of basic infrastructure and clinicians to deliver optimal care in low‐ and middle‐income countries, and persistent healthcare inequities in minority populations in high‐income countries 7,11,12 …”

“…As evident in the current issue, these sciences have been adopted widely by departments in Europe, Asia, and North America with evidence of improved quality. [3][4][5][6][7][8][9][10][11][12][13] Also evident is the variability in pediatric anesthesia quality across the world, noted by the lack of basic infrastructure and clinicians to deliver optimal care in low-and middle-income countries, and persistent healthcare inequities in minority populations in high-income countries. 7,11,12 It is instructive to review the definitions and the key steps in the journey to improving quality and safety.…”

“…9 At the Children's Hospital of Philadelphia, Elliot et al review medication safety in pediatric anesthesia and the QI projects undertaken at their hospital to improve medication safety, while Missett et al deployed QI for education of EEG guided propofol anesthesia into the clinical practice. 4,10 The departments of pediatric anesthesia in Australia and New Zealand have robust national safety reporting, whereas other aspects of quality infrastructure appear less developed. 8 In the specialty societies, the Society for Pediatric Anesthesia (SPA) and the Indian Association in Pediatric Anesthesia (IAPA) formed Quality and Safety Sections to facilitate learning across departments in the country.…”

“…Waddel emphasized the importance of QI data visualization to engage clinicians and bring their projects to success 9 . At the Children's Hospital of Philadelphia, Elliot et al review medication safety in pediatric anesthesia and the QI projects undertaken at their hospital to improve medication safety, while Missett et al deployed QI for education of EEG guided propofol anesthesia into the clinical practice 4,10 . The departments of pediatric anesthesia in Australia and New Zealand have robust national safety reporting, whereas other aspects of quality infrastructure appear less developed 8 .…”

Anesthesia management of neonates and infants requiring intraoperative neurophysiological monitoring: A concise review

“…EEG monitoring devices analyzing waveforms and showing processed signals such as spectral edge frequency and density spectral array could be helpful. Appropriate training in the interpretation of raw EEG waves and processed signals may improve the delivery of general anesthesia with IONM in infants and young children 10 . Anesthesiologists must maintain normal physiological status in children.…”