PSSS – Pediatric Sedation State Scale

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Safe and efficacious procedural sedation practices have always been a goal of hospital care at Boston Children’s Hospital (BCH).  Procedural sedation occurs in a wide variety of hospital settings; these areas include Radiology (Interventional Radiology, CT, and Nuclear Medicine), Dentistry, Oral Surgery/Plastics, Otolaryngology, and the Dana Farber Cancer Institute-Boston Children’s Hospital (DFCI-BCH) Jimmy Fund Clinic.  The pediatric sedation regimens in these settings can vary considerably both in terms of the type of provider overseeing the sedative procedures and the extent to which standard protocols adequately achieve an appropriate sedated “state” over time. Patient “state” is defined using a combination of behavioral observations along with the presence or absence of side effects from the sedative agents used.  The purpose of this study, using expert observational analysis, is to validate an objective Pediatric Sedation State Scale (PSSS) that can quantifiably identify the achievement and maintenance of a safe and effective sedative “state” in the pediatric patient across a range of settings, procedures, and providers. Application of this scale will help improve procedural sedation practice quality and safety at BCH and, ultimately, other healthcare centers, thereby creating a higher level of satisfaction for patients, family, and health care providers.

Projects Status: 

Enrollment has finished and data from that collection effort in the process of being analyzed.

Approved Study Materials:

Our Collaborators:

Validation of the Pediatric Sedation State Scale (PSSS) will occur initially in the following clinics, with sedation providers as co-investigators, at Boston Children’s Hospital and the Dana-Farber Cancer Institute’s Jimmy Fund Clinic.

  • Interventional Radiology: Floreen Knight, RN, BSN
  • Dentistry: Isabelle Chase, DDS
  • Oral and Maxillofacial Surgery: Hannah Desrochers, RN
  • Otolaryngology: Susan Keuker, MSN, FNP
  • Boston Children’s Hospital/Dana-Farber Jimmy Fund Clinic: Jeanine McManus

SPAIN – Society for Pediatric Anesthesia Improvement Network

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This national quality improvement project is an effort to develop a multicenter registry on the perioperative anesthesia course and management of children undergoing surgery for chest wall deformities.   While chest wall deformities in children are relatively common (approximately 1 out of every 400 births), corrective surgery remains complex.  There is significant debate as to which pain control methodology is best.  Moreover, there is reluctance in any one institution to trial or randomize patients to a variety of treatment modalities.  Hence, we are developing a multi-institutional data sharing in which up to 20 participating medical centers are collaborating to better understand the outcomes of perioperative care for patients having corrective surgery.

Our primary objective is to create a multicenter registry which captures information relating to anesthesia course and management and to examine the practice patterns and incidence of complications. Data from any single institution will be used for local safety and quality improvement efforts.  Data from each institution can be compared to the information from all institutions, thus providing a measure for comparison with national practice. The aggregate multi-institutional data set will be used to develop quality benchmarks for national safety/quality improvement efforts and best practice recommendations.  This registry will also demonstrate how web-based data collection can be used to evaluate clinical anesthesia outcomes for surgeries with a low incidence of critical events but significant variability in medical management.

Approved Clinical Research Documentation:

Project Status:

Enrollment for this project is closed. Investigators are collecting follow-up data only.

Our Collaborators:

Sponsor:  Society for Pediatric Anesthesia Quality and Safety Committee

  • All Children’s Hospital, St. Petersburg, FL:  Allison Fernandez, MD
  • Children’s Hospital Colorado, CO:  Seth Eisdorfer, MD; Alan Bielsky, MD; James J. Thomas, MD
  • Children’s Hospital Los Angeles, CA:  Giovanni Cucciaro, MD
  • Children’s Hospital of Philadelphia, PA:  Lynne G. Maxwell, AB, MD;  Wallis T. Muhly, MD
  • Dartmouth-Hitchcock Medical Center, NH:  Jennifer E. O’Flaherty, MD;  Christopher Chin, MD
  • Dupont Hospital for Children, DE:  Dinesh K. Choudhry, MD, FRCA
  • Emory University School of Medicine, GA:  Carolyn Bannister, MD, FAAP
  • Johns Hopkins Charlotte R. Bloomberg Children’s Center, MD:  Sabine Kost-Byerly, MD
  • Mayo Clinic College of Medicine, MN:  Dawit T. Haile, MD;  Robert T. Wilder, MD, PhD
  • Medical University of South Carolina: Gregory D. Schnepper, MD
  • Nationwide Children’s Hospital: Tarun Bhalla, MD; Ralph J. Beltran, MD; Jseph D. Tobias, MD
  • Texas Children’s Hospital, TX:  Chris Darrel Glover, MD;  Imelda Tjia, MD

PACU – Post Anesthesia Care Unit Outcomes Project

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Quality outcomes in the Post Anesthesia Care Unit (PACU) have always been a goal of hospital care at Boston Children’s Hospital (BCH). A considerable number of metrics can be used to measure quality of outcomes in the PACU – such as the incidence of postoperative pain, the incidence and degree of emergence delirium, and number of patients who experience post-operative vomiting. The purpose of this study is to evaluate the quality of outcomes in the PACU at BCH and to identify preoperative demographic and behavioral data as well as intraoperative and anesthetic predictors of adverse PACU outcomes. We believe this will help us improve post anesthetic care quality and create a higher level of satisfaction for patients, family, and health care providers.

Approved Clinical Research Documentation:

Project Status:

Enrollment has finished and data from that collection effort in the process of being analyzed. In addition automated data collection efforts are being continued.

Our Collaborators:

Richard Blum, MD
Post Anesthesia Care Unit Director,
Department of Anesthesia, Perioperative and Pain Medicine,
Boston Children’s Hospital

All Staff and Nursing Providers,
Post Anesthesia Care Unit (PACU),
Boston Children’s Hospital