Perspectives in Pediatric Ambulatory Anesthesia: Part 2-One Center's 15 Year Experience Improving Quality and Safety Outcomes.

introductionPediatric ambulatory surgery has become the dominant model of surgical care in the United States, driven primarily by economic forces. There is variability in regional practice patterns, quality improvement cycles, and outcomes. Opportunity exists to overcome knowledge gaps and provide sustainable pathways of quality improvement. Our unique capability of describing the evolution of our pediatric ambulatory quality improvement practice allows us to contribute a single center's perspective.

methodsWe chose to complete a comprehensive retrospective review of our quality improvement process, outcome, and balancing metrics contained in our electronic health record (EHR) from our free-standing pediatric ambulatory surgery center (ASC) from July 2010 through December 2024. A commercial software system extracted de-identified, aggregated health data from the system's EHR. The data are processed and presented in statistical process control charts. This methodology allows clinicians to distinguish between common cause and special cause variation.

resultsImprovement themes (opioid-free anesthesia and stewardship, enhanced recovery, environmental efforts, positive deviance, and learning healthcare system) are described. Improvements in all six domains of quality (effectiveness, efficiency/timeliness, patient experience, equity, and safety) are illustrated with reliable sustainability. Our system achieved approximately a 13-fold increase in quality improvement (QI) project completion rate with self-serve, real-world data access; enabling the team to take on improvement tasks previously deemed too big, lengthy, or risky to complete. DISCUSSION: We provide preliminary evidence that these methods may be generalizable. Requirements include engaged leadership, a standard framework for improvement with experienced leadership or accessible support, and easy access to real-world electronic medical record data (i.e., learning healthcare system [LHS]). Lastly, leaders must create a culture supportive of teamwork, change, and continuous improvement. Systems facilitate adoption and hinder resistance to standards, always with implementation and sustainability in mind. Meaningful, large-scale improvements in healthcare outcomes require collaboration across LHSs.