{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T19:14:26Z","timestamp":1788894866504,"version":"build-2803163510"},"reference-count":50,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pediatric ambulatory surgery has become the dominant model of surgical care in the United States, driven primarily by economic forces. There is variability in regional practice patterns, quality improvement cycles, and outcomes. Opportunity exists to overcome knowledge gaps and provide sustainable pathways of quality improvement. Our unique capability of describing the evolution of our pediatric ambulatory quality improvement practice allows us to contribute a single center's perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We chose to complete a comprehensive retrospective review of our quality improvement process, outcome, and balancing metrics contained in our electronic health record (EHR) from our free\u2010standing pediatric ambulatory surgery center (ASC) from July 2010 through December 2024. A commercial software system extracted de\u2010identified, aggregated health data from the system's EHR. The data are processed and presented in statistical process control charts. This methodology allows clinicians to distinguish between common cause and special cause variation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Improvement themes (opioid\u2010free anesthesia and stewardship, enhanced recovery, environmental efforts, positive deviance, and learning healthcare system) are described. Improvements in all six domains of quality (effectiveness, efficiency\/timeliness, patient experience, equity, and safety) are illustrated with reliable sustainability. Our system achieved approximately a 13\u2010fold increase in quality improvement (QI) project completion rate with self\u2010serve, real\u2010world data access; enabling the team to take on improvement tasks previously deemed too big, lengthy, or risky to complete.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>We provide preliminary evidence that these methods may be generalizable. Requirements include engaged leadership, a standard framework for improvement with experienced leadership or accessible support, and easy access to real\u2010world electronic medical record data (i.e., learning healthcare system [LHS]). Lastly, leaders must create a culture supportive of teamwork, change, and continuous improvement. Systems facilitate adoption and hinder resistance to standards, always with implementation and sustainability in mind. Meaningful, large\u2010scale improvements in healthcare outcomes require collaboration across LHSs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pan.70252","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T05:51:30Z","timestamp":1783144290000},"page":"1196-1206","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Perspectives in Pediatric Ambulatory Anesthesia: Part 2\u2014One Center's 15\u2009Year Experience Improving Quality and Safety Outcomes"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4363-9157","authenticated-orcid":false,"given":"Jennifer L.","family":"Chiem","sequence":"first","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine Seattle Children's\/University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7388-2612","authenticated-orcid":false,"given":"Elizabeth E.","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine Seattle Children's\/University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayla","family":"Reece","sequence":"additional","affiliation":[{"name":"Department of Perioperative Services Seattle Children's  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2489-6070","authenticated-orcid":false,"given":"Samuel M.","family":"Vanderhoek","sequence":"additional","affiliation":[{"name":"Division of Pediatric Anesthesiology, Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay R.","family":"Parikh","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Seattle Children's\/University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4816-4288","authenticated-orcid":false,"given":"Paul A.","family":"Merguerian","sequence":"additional","affiliation":[{"name":"Department of Urology Seattle Children's\/University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9513-8763","authenticated-orcid":false,"given":"Lynn D.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine Seattle Children's\/University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000007169"},{"key":"e_1_2_13_3_1","article-title":"Perspectives in Pediatric Ambulatory Anesthesia: Part 1\u2014One Center's Experience Over 15\u2009Years in the Evolution of Eligibility Criteria and the COVID Pandemic","author":"Low A. 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