Competence Centres for Children

Dr Karin Becke MDChair of Scientific Subcommittee Paediatric Anaesthesiology, ESA

Chair of German Working Group Paediatric Anaesthesia, DGAI

Head of Department of Anaesthesia and Intensive Care Medicine,

Cnopf Children´s Hospital Nürnberg, Germany

STOA WorkshopImproving Outcomes for Critically Ill Children:

Innovation and Research Translated to Save Lives

Is anaesthesia safe in children?

The younger the child, the more in-experienced the team, the higher the risk

Severe complications including cardiacarrest occur 10 times more frequently

Experience of the teamAge of the child

Risk

Children should be referred to a centerPrerequisites (staff, equipment, facilities)must be complied with

www.sgar-ssar.ch/patientensicherheit/

Is anaesthesia safe in children?

Cardiac arrest in paediatic anaesthesia

0

5

10

15

20

25

1-18 a 1-12 m 0-1 m

x 4 x 6

Gobbo Braz L et al. Paediatr Anaesth 2006Bhananker SM et al Anesth Analg 2007Flick RP et al. Anaesthesiology 2007

Van der Griend BF et al Anesth Analg 2011American Academy of Pediatrics. Pediatrics 2015

Correlation of complications & case load

Complications / 1000 anaesthetics

Cas

elo

adan

aest

hetic

s/an

aest

hesi

olog

ist/

year

Auroy Y et al. Anesth Analg 1997

Competence Centres• National Confidential Enquiry into Patient Outcome and Death

– A review of organisational and clinical aspects of children´s surgery

DistrictGeneral

Hospitals< 500 beds

DistrictGeneral

Hospitals> 500 beds

PrivateHospitals

SingleSpecialtyHospitals

2/3 of children are treatedin non-specialized centres!

SpecialistTertiary

PaediatricCentres

UniversityTeachingHospitals

http://www.ncepod.org.uk

ESA – APRICOT Study

• Prospective multicenter observational trial– Europe: 33 countries, 265 centres– More than 30.000 anaesthetics in 2015

• Endpoints– Epidemiology, perioperative severe adverse events

Preliminary results: massive variation across EU

Paediatric Anaesthesia in Europe

To-do´s:Harmonization of practice in paediatricanaesthesiaPatient safetySystem safety

Paediatric Anaesthesia Services

• Education– Training, specialist programs (Fellowship)

• GuidelinesRecommendations for Paediatric AnaesthesiaServices in EU (Task Force ESA)

• Staffing, equipment, facilities• Organization in non-specialized centres• Standards of practice (SOPs)

• Outcome registry– Patient-centred outcome measures

Patient Safety System Safety

Patient safety

Van Aken H et al. Best Pract Res Clin Anaesthesiol 2011.

Change in culture

System Safety

MedicalSocieties

Interdisc.Collaboration

Politics/Policy

EBM/Guidelines

Research

QualityImprovement

EACH CharterEuropean Association for Children in Hospital

• Article 8:“Children shall be cared forby staff whose trainingand skills enable them torespond to the physical,emotional and develop-mental needs of children“.