{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T20:56:25Z","timestamp":1764276985038,"version":"3.40.5"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,1,14]],"date-time":"2020-01-14T00:00:00Z","timestamp":1578960000000},"content-version":"vor","delay-in-days":0,"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":[[2020,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Postoperative pain is a significant cause of morbidity in pediatric anesthesia, which can result in delayed discharge and unplanned hospital admission. Children undergoing strabismus surgery are known to be a particularly high\u2010risk group for postoperative pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>The aim of this project was to reduce the incidence of moderate to severe postoperative pain by 25% over a period of 12\u00a0months in children undergoing strabismus surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a multidisciplinary quality improvement project using the Institute for Healthcare Improvement model for improvement and iterative Plan\u2010Do\u2010Study\u2010Act cycles. Baseline data from one hundred patients were collected retrospectively from patient records. Subsequently, iterative interventions introduced comprised: a perioperative bundle (comprising preoperative acetaminophen, intraoperative dexamethasone and ketorolac, a long\u2010acting opioid, and two anti\u2010emetics), email reminders, dissemination of results at departmental rounds, and an intraoperative clinical decision aide. Postoperative pain data were collected as an outcome measure, and length of stay in PACU was monitored as a balancing measure. Statistical process control charts were constructed to monitor bundle compliance and incidence of postoperative pain in the postanesthesia care unit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Postoperative pain and bundle compliance data were collected for 1127 children in total. Baseline mean monthly incidence of moderate to severe postoperative pain was 47.3%. By the conclusion of this project, the incidence of postoperative pain decreased to 21%. Concurrently, mean bundle compliance increased to 78.7%. Mean length of PACU stay for baseline audit patients was 72.5\u00a0min compared with 70\u00a0min for patients after the introduction of the strabismus macro (November 2018\u2010April 2019, n 91) (mean difference, 2.5; 95% CI, \u22123.86 to 8.86; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.439).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Through the implementation and adoption of an evidence\u2010based bundle of care, we successfully decreased the incidence of moderate to severe postoperative pain for children undergoing strabismus repair. We demonstrated that combining nudge theory with QI methodology can be an effective means of delivering positive results in quality improvement projects.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.13811","type":"journal-article","created":{"date-parts":[[2019,12,31]],"date-time":"2019-12-31T01:00:37Z","timestamp":1577754037000},"page":"415-423","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Reducing postoperative pain in children undergoing strabismus surgery: From bundle implementation to clinical decision support tools"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9285-7658","authenticated-orcid":false,"given":"Usman","family":"Ali","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Pain Medicine The Hospital for Sick Children University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maisie","family":"Tsang","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine The Hospital for Sick Children University of Toronto Toronto ON Canada"},{"name":"Department of Anesthesiology &amp; Pain Medicine University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiona","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine The Hospital for Sick Children University of Toronto Toronto ON Canada"},{"name":"Department of Anesthesiology &amp; Pain Medicine University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9502-0981","authenticated-orcid":false,"given":"Clyde","family":"Matava","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine The Hospital for Sick Children University of Toronto Toronto ON Canada"},{"name":"Department of Anesthesiology &amp; Pain Medicine University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brenda","family":"Igbeyi","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine The Hospital for Sick Children University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sindu","family":"Balakrishnan","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine The Hospital for Sick Children University of Toronto Toronto ON Canada"},{"name":"Department of Anesthesiology Hamad Medical Corporation Hamad Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Shackell","sequence":"additional","affiliation":[{"name":"Post Anesthesia Care Unit The Hospital for Sick Children Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gloria","family":"Kotzer","sequence":"additional","affiliation":[{"name":"Post Anesthesia Care Unit The Hospital for Sick Children Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6868-7089","authenticated-orcid":false,"given":"Conor","family":"Mc Donnell","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine The Hospital for Sick Children University of Toronto Toronto ON Canada"},{"name":"Department of Anesthesiology &amp; 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