Tracking and Reporting Outcomes Of Procedural Sedation (TROOPS): Standardized Quality Improvement and Research Tools from the International Committee for the Advancement of Procedural Sedation

Roback, Mark G.; Green, S. M.; Andolfatto, Gary; Leroy, Piet L. J. M.; Mason, Keira P.

doi:10.1016/j.bja.2017.08.004

Cited by 55 publications

(56 citation statements)

References 18 publications

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“…A strength of APRICOT was the use of detailed, standardised definitions of serious critical events in paediatric anaesthesia and this could form the basis of a reporting and quality improvement system in Europe similar to that developed in the USA . Recently, a tool for reporting adverse events associated with paediatric sedation was developed and this could be a good model to follow for peri‐operative serious critical event reporting and quality improvement .…”

Section: Discussionmentioning

confidence: 99%

Incidence of severe critical events in paediatric anaesthesia in the United Kingdom: secondary analysis of the anaesthesia practice in children observational trial (APRICOT study)

et al. 2018

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The anaesthesia practice in children observational trial of 31,127 patients in 261 European hospitals revealed a high (5.2%) incidence of severe critical events in the peri-operative period and wide variability in practice. A sub-analysis of the UK data was undertaken to investigate differences compared with the non-UK cohort in the incidence and nature of peri-operative severe critical events and to attempt to identify areas for quality improvement. In the UK cohort of 7040 paediatric patients from 43 hospitals, the overall incidence of perioperative severe critical events was lower than in the non-UK cohort (3.3%, 95%CI: 2.9-3.8 vs. 5.8%, 95%CI: 5.5-6.1, RR 0.57, p < 0.001). There was a lower rate of bronchospasm (RR 0.22, 95%CI: 0.14-0.33; p < 0.001), stridor (RR 0.42, 95%CI: 0.28-0.65; p < 0.001) and cardiovascular instability (RR 0.69, 95%CI: 0.55-0.86; p = 0.001) than in the non-UK cohort. The proportion of sicker patients where less experienced teams were managing care was lower in the UK than in the non-UK cohort (10.4% vs. 20.4% of the ASA physical status 3 and 9% vs. 12.9% of the ASA physical status 4 patients). Differences in work-load between centres did not affect the incidence and outcomes of severe critical events when stratified for age and ASA physical status. The lower incidence of cardiovascular and respiratory complications could be partly attributed to more experienced dedicated paediatric anaesthesia providers managing the higher risk patients in the UK. Areas for quality improvement include: standardisation of serious critical event definitions; increased reporting; development of evidence-based protocols for management of serious critical events; development and rational use of paediatric peri-operative risk assessment scores; implementation of current best practice in provision of competent paediatric anaesthesia services in Europe; development of specific training in the management of severe peri-operative critical events; and implementation of systems for ensuring maintenance of skills.

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Section: Discussionmentioning

confidence: 99%

Incidence of severe critical events in paediatric anaesthesia in the United Kingdom: secondary analysis of the anaesthesia practice in children observational trial (APRICOT study)

et al. 2018

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“…An important advance in the evaluation of procedural sedation adverse events for quality improvement and for research is the shift away from event and threshold-based definitions (eg, apnea for >30 s) to the more clinically relevant intervention-based orientation (eg, assisted ventilation for apnea). 8,10 The act of performing an intervention is typically unambiguous, and thus more likely to be reported in a standardized, reproducible fashion. Intervention-based definitions better predict clinical importance, as any event would be trivial if no intervention was performed in response to its occurrence.…”

Section: Intervention-oriented Definitions For Adverse Eventsmentioning

confidence: 99%

“…Intervention-based definitions better predict clinical importance, as any event would be trivial if no intervention was performed in response to its occurrence. 8,10 Periodic interventions are an expected part of procedural sedation practice, and their performance does not necessarily signify a clinical error.…”

Section: Intervention-oriented Definitions For Adverse Eventsmentioning

confidence: 99%

“…An example of a standardized tool for this purpose is TROOPS (Tracking and Reporting Outcomes Of Procedural Sedation, http://proceduralsedation.org/troopsoverview), 10 which was developed through a rigorous multidisciplinary consensus process.…”

Section: Quality Improvementmentioning

confidence: 99%

“…First, as with this document, we believe that there should be greater collaboration between specialties in the development and oversight of optimal practice recommendations for this long-standing multidisciplinary field. 9,10,14,[43][44][45][46] Although the safety of procedural sedation practice by a variety of specialists is now well established, research should focus on patient-centered outcomes. How can we improve the quality of the experience for patients and their families?…”

Section: The Futurementioning

confidence: 99%

See 2 more Smart Citations

Unscheduled Procedural Sedation: A Multidisciplinary Consensus Practice Guideline

Green¹,

Roback²,

Krauss³

et al. 2019

Annals of Emergency Medicine

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(ACEP) organized a multidisciplinary effort to create a clinical practice guideline specific to unscheduled, time-sensitive procedural sedation, which differs in important ways from scheduled, elective procedural sedation. The purpose of this guideline is to serve as a resource for practitioners who perform unscheduled procedural sedation regardless of location or patient age. This document outlines the underlying background and rationale, and issues relating to staffing, practice, and quality improvement. [

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Association of Preprocedural Fasting With Outcomes of Emergency Department Sedation in Children

et al. 2018

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; for the Sedation Safety Study Group of Pediatric Emergency Research Canada IMPORTANCE It is not clear whether adherence to preprocedural fasting guidelines prevent pulmonary aspiration and associated adverse outcomes during emergency department (ED) sedation of children. OBJECTIVE To examine the association between preprocedural fasting duration and the incidence of sedation-related adverse outcomes in a large sample of children. DESIGN, SETTING, AND PARTICIPANTS We conducted a planned secondary analysis of a multicenter prospective cohort study of children aged 0 to 18 years who received procedural sedation for a painful procedure in 6 Canadian pediatric EDs from July 2010 to February 2015. The primary risk factor was preprocedural fasting duration. Secondary risk factors were age, sex, American Society of Anesthesiologists classification, preprocedural and sedation medications, and procedure type. MAIN OUTCOMES AND MEASURES Four outcomes were examined: (1) pulmonary aspiration, (2) the occurrence of any adverse event, (3) serious adverse events, and (4) vomiting. RESULTS A total of 6183 children with a median age of 8.0 years (interquartile range, 4.0-12.0 years), of whom 6166 (99.7%) had healthy or mild systemic disease (American Society of Anesthesiologists levels I or II), were included in the analysis. Of these, 2974 (48.1%) and 310 (5.0%) children did not meet American Society of Anesthesiologists fasting guidelines for solids and liquids, respectively. There were no cases of pulmonary aspiration. There were 717 adverse events (11.6%; 95% CI, 10.8%-12.4%), of which 68 (1.1%; 95% CI, 0.9%-1.3%) were serious adverse events and 315 (5.1%; 95% CI, 4.6%-5.7%) were vomiting. The odds ratio

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Tracking and Reporting Outcomes Of Procedural Sedation (TROOPS): Standardized Quality Improvement and Research Tools from the International Committee for the Advancement of Procedural Sedation

Cited by 55 publications

References 18 publications

Incidence of severe critical events in paediatric anaesthesia in the United Kingdom: secondary analysis of the anaesthesia practice in children observational trial (APRICOT study)

Incidence of severe critical events in paediatric anaesthesia in the United Kingdom: secondary analysis of the anaesthesia practice in children observational trial (APRICOT study)

Unscheduled Procedural Sedation: A Multidisciplinary Consensus Practice Guideline

Association of Preprocedural Fasting With Outcomes of Emergency Department Sedation in Children

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