Specialised training in paediatric anaesthesia: Need of the hour

Wake Up Safe in the USA & International Patient Safety

Patient safety is the most important aspect of anesthetic care. For both healthcare professionals and patients, the ideal would be no significant morbidity or mortality under anesthesia. Lessons from harm during healthcare can be shared to reduce harm and to increase safety. Many nations and individual institutions have developed robust safety systems to improve the quality and safety of patient care. Large registries that collect rare events, analyze them, and share findings have been developed. The approach, the funding, the included population, support from institutions and government and the methods of each vary. Wake Up Safe (WUS) is a patient safety organization accredited by Agency for Healthcare Research and Quality. Wake Up Safe was established in the United States in 2008 by the Society for Pediatric Anesthesia. The initiative aims to gather data on adverse events, analyze these incidents to gain insights, and apply this knowledge to ultimately reduce their occurrence. The purpose of this review is to describe the patient safety approaches in the USA. Through a national patient safety database WUS. Similar approaches either through WUS international or independent safety approaches have been described in Australia-New Zealand, India, and Singapore. We examine the patient safety processes across the four countries, evaluating their incident review process and the distribution of acquired knowledge. Our focus is on assessing the potential benefits of a WUS collaboration, identifying existing barriers, and determining how such a collaboration would integrate with current incident review databases or systems.

Quality improvement and patient safety in India-Present and future

India is a vast, populous and diverse country, and this reflects in the state of health care as well. The spectrum of healthcare services ranges from world class at one end, to a dearth of resources at the other. In the rural areas especially, there is a shortage of trained medical personnel, equipment, and medications needed to carry out safe surgery. Several initiatives have and are being made by the government, medical societies, hospitals, and nongovernment organizations to bridge this gap and ensure equitable, safe, and timely access to health for all. Training medical personnel and healthcare workers, accreditation of healthcare facilities, guidelines, and checklists, along with documentation and audit of practices will all help in improving services. This narrative review discusses the measures that have been taken, systems that have been established and the challenges involved in ensuring quality and patient safety in India.

Safe surgery for every child, implementation of paediatric anaesthesia training in Nigeria

PURPOSE OF REVIEW

Nigeria is the most populous country in Africa and 43.5% of its population is under 15 years. Most of these children do not have access to specialized paediatric anaesthesia care when needed, as there are only few paediatric anaesthetists in the country. We highlight the barriers to safe anaesthesia in children, present training opportunities in paediatric anaesthesia and the need for additional, more extensive training in Nigeria.

RECENT FINDINGS

The Nigerian paediatric anaesthesia workforce is minimal with a dismal paediatric anaesthetist to child density of 0.028 per 100 000 children <15 years old. Training opportunities in paediatric anaesthesia exist during residency, diploma and master's programmes. Short paediatric anaesthesia-related courses are also provided, sometimes by partnering with nongovernmental organizations. There is at present, no Fellowship training programme in Nigeria, to train specialists and leaders in paediatric anaesthesia.

SUMMARY

To solve the urgent problem of acute shortage of paediatric anaesthetists in Nigeria, general anaesthetists should be empowered through short courses to provide safe anaesthesia for children. A comprehensive Fellowship programme is urgently needed to train specialists in paediatric anaesthesia. Equipment upgrade, creation of children's hospitals and empowerment for research are important end points that require governmental support.

Challenges of Pediatric Anesthesia Services and Training Infrastructure in Tertiary Care Teaching Institutions in Pakistan: A Perspective From the Province of Sindh

BACKGROUND

Pakistan is a lower middle-income country located in South Asia with a population of nearly 208 million. Sindh is its second largest province. The aim of this survey was to identify the current setup of pediatric services, staffing, equipment, and training infrastructure in the teaching hospitals of Sindh.

METHODS

The survey was conducted between June 2018 and September 2018. A questionnaire was designed with input from experts and pretested. One faculty coordinator from each of 12 of the 13 teaching hospitals (7 government and 5 private) completed the form. Information was exported into Statistical Package for the Social Sciences (SPSS) version 22. Frequency and percentages were computed for all variables. Confidentiality was ensured by anonymizing the data.

RESULTS

Anesthesia services are provided by consultants with either membership or fellowship in anesthesia of the College of Physicians and Surgeons of Pakistan (CPSP). All drugs on the World Health Organization (WHO) essential medication list were available, although narcotic supply was often inconsistent. Weak areas identified were absence of standardization of practice regarding premedication, preoperative laboratory testing, pain assessment, and management. No national practice guidelines exist. Pulse oximeters and capnometers were available in all private hospitals but in only 86% and 44% of the government hospitals, respectively. Some training centers were not providing the training as outlined by the CPSP criteria.

CONCLUSIONS

Several gaps have been identified in the practice and training infrastructure of pediatric anesthesia. There is a need for national guidelines, standardization of protocols, provision of basic equipment, and improved supervision of trainees. One suggestion is to have combined residency programs between private and government hospitals to take advantage of the strengths of both. Recommendations by this group have been shared with all teaching hospitals and training bodies.