Project Leads

Dr. Robin G. Cox, Professor, Section of Pediatric Anesthesia, University of Calgary

Dr. Lara Cooke, Associate Dean, Continuing Medical Education and Professional Development, University of Calgary

Objective

This project aims to gather data that describes current anesthesiology practices at Alberta Children’s Hospital (ACH) for pediatric tonsillectomy surgery and to link that data with outcome measures for each patient. The objective will be to correlate perioperative variables with outcomes, with the goal of improving and optimizing these patient outcomes in the future.

Background and Rationale

Tonsillectomy is a common and largely ambulatory surgical procedure in children. At AHC, about 1000 children undergo tonsillectomy each year with approximately 80% of these children going home the day of procedure.  Although tonsillectomy is widely regarded as a safe and simple procedure, serious complications do occur.  Post-operative discomfort due to post-operative nausea and vomiting (PONV), decreased oral intake and pain is common. Studies have shown that anesthesia technique may affect patient outcomes. Patient outcomes post-discharge from AHC are not documented for this largely ambulatory surgical procedure.

Study Design

This prospective cohort study will link anesthesia technique to patient outcomes during the first 24 hours post-surgery.  Data describing anesthesia technique will be extracted from an automated intraoperative anesthesia record (Picis Anesthesia Manager ®). Data describing patient outcomes will be collected during hospital stay through an electronic database (Sunrise Clinical Manager) and paper forms. Data describing patient outcomes post-discharge will be collected via a follow-up phone call.

Project Update:

• 100% of pediatric anesthesiologists participated in project.

• Consenting anesthesiologists received confidential, practice data reports with individual and peer comparator data; 65% of project participants attended an interactive feedback session with peer facilitator.

• Multivariate regression analysis in progress.

Scholarship:

• Cox R, McMann J, Letal M, Duncan D, Spencer A, Cooke L. Practice improvement by tracking pediatric tonsillectomy outcomes.  Poster discussion at Canadian Anesthesiologists’ Society Annual Meeting, 2015.

• Cox R, Hardegger K, Duncan D, Letal M, Spencer A, McMann J, Cooke LJ. Connecting patient outcomes to physicians’ administrative health data reports to encourage reflective self-assessment in practice. Oral presentation at the Canadian Conference on Medical Education, 2015.