Anesthesia Quality Improvement Pediatric Outcomes
Case Info
Anesthesia type
Date
Provider ID
MR #
CRNA ID
ASA Class
Additional provider
Co-morbidities:
Arrhythmia
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Reactive Airway disease
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Diabetes
Single Ventricle
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Trach/Laryn/Bronch
Malacia
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GERD
CHF
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Difficult Airway
Hypertension
OSA
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Metabolic
disorder
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Spina Bifida
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Failure to thrive
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H/O SIDS
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Cyanotic CHD
Acyanotic CHD
Pulmonary HTN
Valve Disease
Cardiomyopathy
Cystic Fibrosis
VC Dysfunction
Pneumonia
BPD/CLD
NO UNTOWARD EVENT
Airway Trauma
Aspiration
Laryngospasm
Bronchospasm
New
Croup/Stridor
Hypoxia w/esc
Reintubation
Respiratory
Arrest
Unable to
Intubate
Prolonged
Intub/Vent
Unrecog Diff
Airway
Equip
Malfunction
Fall
Unpl Hosp Admit
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Anaphylaxis
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Latex Allergy
H/O of ED
Cerebral Palsy
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Hydrocephalus
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Other
Hemaglobinopathy
Liver disease/failure
Renal Disease/failure
Hematologic
Endocrine other
Chromo Anomaly
Obesity
Premi < 37 weeks
Downs
Seizures
Developmental Delay
Intracranial
Hemorrhage
Death (Excludes ASA 6 patients presenting for harvesting)
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Failed Regional Block
Pulmonary Edema/CHF
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Transfusion Reaction
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Post Dur Punc
Headache
Periph Neuro Deficit
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Myocardial Infarction
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ECMO
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Burn
Incorrect Op Site
Unplanned Dural Punc
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Medication Error
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Visual Loss
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Prolonged PACU stay
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SaO2<90>60s-NonCyan
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Unpl Post Op Vent
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Unpl ICU Admit
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Eye Injury
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Dental Trauma
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Pneumothorax
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Hypotherm in PACU
<36c
Incorrect Patient
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Intractable N/V
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Prolonged NM Block
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Malig Hyperthermia
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Return to OR
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Arrhythmia req tmt
Cardiac Arrest
Shock
Vascular Acc Compl
High Spinal
Inad epidural/caudal
CNS Injury
Seizure
This is a template. Please modify for local conditions.
The definitions for each measure can be found on the AQI website.
Case Cx Pre Induction
Case Cx Post Induction
Emergence delirium
Inad Pain Control
Intraop Awareness
Not Part of Patient’s chart
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