{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T12:14:16Z","timestamp":1740140056908,"version":"3.37.3"},"reference-count":24,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,10,9]],"date-time":"2018-10-09T00:00:00Z","timestamp":1539043200000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>An electronic review of unplanned day case admission rates in our hospital demonstrated an average annual rate for pediatric circumcision of 2%\u20103% in recent years with high levels of perioperative strong opiate use. This lay above target unplanned admission rates (&lt;2%) set out by the Royal College of Anaesthetists for day case surgery. A targeted quality improvement initiative was undertaken to improve patient flow through the pediatric day case surgery unit for elective circumcision. Among the reasons for unplanned admission, factors modifiable by the anesthetist (pain, postoperative nausea and vomiting, somnolence) are significant contributors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective audit was undertaken over a 3\u2010month period. Our practice was compared with evidence\u2010based analgesic and antiemetic interventions in accordance the Association of Paediatric Anaesthetists of Great Britain and Ireland. Perioperative strong opiate administration rates occurred in 44% of cases. Four strategic interventions were selected based on quality of evidence, ease of implementation, and low cost: selection of higher concentration local anesthetic use for penile blocks, intravenous dexamethasone, and preoperative paracetamol combined with maximum dose nonsteroidal anti\u2010inflammatory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The audit was duplicated a year later demonstrating a significant increase in application of these interventions with a parallel fall in strong opiate use from 44% to 9% and an unprecedented zero unplanned admission rate in our unit for 10\u00a0months in a row after implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Regular scrutiny of patient electronic data helps identify high impact areas for audit and intervention. Unplanned admission in pediatric day case surgery is an area amenable to such targeted intervention.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.13474","type":"journal-article","created":{"date-parts":[[2018,10,10]],"date-time":"2018-10-10T05:28:34Z","timestamp":1539149314000},"page":"924-929","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A simple care bundle to reduce unplanned admission rate for day case pediatric circumcision"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2729-4067","authenticated-orcid":false,"given":"David Joel","family":"Stoeter","sequence":"first","affiliation":[{"name":"Jackson Rees Department of Anaesthesia Alder Hey Children's Hospital Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Roberts","sequence":"additional","affiliation":[{"name":"Jackson Rees Department of Anaesthesia Alder Hey Children's Hospital Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,10,9]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Department of Health UK.The NHS plan: a plan for investment a plan for reform. [document on the internet]. London UK: DoH 2000."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h4060"},{"key":"e_1_2_8_4_1","unstructured":"Briefing: Operating theatres\u2010 maximizing a valuable resource [homepage on the internet]. c2014 [updated 2014 Jul 1]. Available from:http:\/\/nhsproviders.org\/media\/1128\/operating-theatres-final.pdf. Accessed January 25 2018."},{"key":"e_1_2_8_5_1","unstructured":"Royal College of Anaesthetists.Raising the standard: a compendium of audit recipes. 3rd Edition. [homepage on the internet]. c2012 [updated 2012]. Available fromhttps:\/\/www.rcoa.ac.uk\/system\/files\/CSQ-ARB-2012_0.pdf. Accessed January 25 2017."},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.0265-0215.2000.00837.x"},{"issue":"10","key":"e_1_2_8_7_1","first-page":"522","article-title":"Unanticipated admission after day surgery","volume":"43","author":"Tham C","year":"2002","journal-title":"Singapore Med J"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003643-200405000-00005"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2008.05438.x"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.2008.01895.x"},{"key":"e_1_2_8_11_1","unstructured":"Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI).PAediatric uPlanned dAYcase Admission (PAPAYA) [homepage on the internet]. c2017 [updated 2017]. Available from:http:\/\/www.apagbi.org.uk\/professionals\/trainee-section\/research-network-patrn\/papaya. Accessed January 25 2018."},{"key":"e_1_2_8_12_1","unstructured":"Association of Anaesthetists of Great Britain and Ireland and the British Association of Day Surgery.Day Case and Short Stay Surgery. [homepage on the internet]. c2011 [updated 2011 May]. Available from:https:\/\/www.aagbi.org\/sites\/default\/files\/Day%20Case%20for%20web.pdf. Accessed January 25 2018"},{"key":"e_1_2_8_13_1","unstructured":"Alder Hey Children's Hospital. Painbusters. [homepage on the internet]. c2013 [updated 2013]. Available from:http:\/\/www.alderhey.nhs.uk\/wp-content\/uploads\/Painbusters-Your-guide-to-pain-relief-at-Alder-Hey.pdf. 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