Clinical outcomes are measurable changes in health, function or quality of life that result from our care. Constant review of our clinical outcomes establishes standards against which to continuously improve all aspects of our practice.
About the Anaesthesia Service
The department of Anaesthesia at Great Ormond Street Hospital (GOSH) is one of the UK's leading centres for the provision of anaesthesia and pain management for children requiring a wide range of surgical, radiological and medical procedures. Approximately 18,000 children are anaesthetised every year.
The department consists of 50 consultants and 30 specialist trainees that provide 24-hour dedicated paediatric anaesthesia services. We also have a leading role in education and training of doctors and other health professionals.
Clinical outcome measures
Each quarter the department collects data from 250 randomly chosen patients (five per cent of the caseload) to help monitor our effectiveness. We measure and report on four specific anaesthetic clinical outcomes:
- Temperature on arrival to Post-Anaesthesia Care Unit (PACU)
- Pain scores on wakening
- Incidence of post-operative nausea and vomiting (PONV)
- Incidence of respiratory complication in PACU
All of the measures show natural variation over time, but are within expected range and show consistently good and improving anaesthetic clinical outcomes for patients. We continue, through our ongoing quality improvement and audit programmes, to improve patient care and outcomes for children receiving anaesthesia and pain management at GOSH.
During anaesthesia and surgery a child’s temperature can drop to below 36.0°C (hypothermia). Hypothermia is associated with a higher risk of complications after surgery. A range of warming devices are used during anaesthesia to prevent hypothermia.
A child’s temperature is measured at regular intervals before and during anaesthesia and on arrival to PACU.
The National Institute for Clinical Excellence (NICE) recommends that a patient’s temperature should be kept above or equal to 36.0°C in adults having surgery under anaesthesia. Although there are no current recommendations for children it is widely agreed that avoidance of hypothermia in children undergoing surgery (excluding heart surgery) is beneficial.
Figure 1: Percentage of patients arriving in PACU with a temperature equal to or above 36.0°C
This graph shows that on average 97 per cent of our patients sampled arrive in recovery with a temperature equal to or above 36.0°C. The average remains consistent since we last reported in April 2017, and is an increase from the average of 95 per cent reported in April 2015.
Pain-relieving drugs are given by the anaesthetist during surgery to ensure that children are as comfortable as possible after surgery. The type and strength of pain relief given will depend on the procedure. After surgery, the specialist nurse in the PACU will assess if the child is comfortable using a simple zero to 10 scale (no pain at zero and worst possible pain at 10). If necessary, the child will receive further pain relief to ensure s/he is comfortable before going to the ward.
Figure 2: Percentage of patients wakening in PACU with a pain score of four or less
This graph shows that on average 92 per cent of our patients arrive in recovery with a pain score of four or less out of 10. This is a small increase from an average of 91 per cent since we last reported in April 2017, and noticeably the trend since the end of 2015/16 is on or above the average.
We apply the same target as Cincinnati Children’s Hospital – to seek to achieve more than 90 per cent of children arriving comfortable in recovery. However, despite a good result, we also share a commitment to continuous improvement, so we expect to increase this score over time.
Some children may suffer sickness (vomiting) or nausea (feeling sick) after anaesthetics. The degree of risk will depend on the child’s medical condition and the nature of surgery for which anaesthesia is being provided. It can usually be prevented or treated effectively.
Figure 3: Percentage of patients that experience nausea or vomiting in PACU
This graph shows that on average two per cent of our patients experience post-operative nausea or vomiting in the PACU. The average remains consistent at two per cent since we last reported in April 2017, and has been maintained since April 2015.
Some children experience breathing problems shortly after waking up from an anaesthetic. The degree of risk will depend on the child’s medical condition and the nature of surgery for which anaesthesia is being provided. Most cases of breathing problems are experienced briefly, and minimal intervention is required.
Our aim is that less than 10 per cent of our patients experience respiratory complications in the PACU, a target we share with Cincinnati Children’s Hospital.
Figure 4: Percentage of patients that experience a respiratory complication in PACU
This graph shows that on average four per cent of our patients experience a respiratory complication in PACU. The average remains consistent since we last reported in April 2017, and is a decrease from five per cent reported in April 2015.
This information was published in November 2018 and will be updated in November 2019.