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We are an
AHRQ designated
Patient Safety Organization

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Start-up funding in part by the Anesthesia Patient Safety Foundation

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For Prospective Participants

Wake up Safe is a Quality Improvement Initiative that contains a registry of serious adverse events occurring in pediatric anesthetics. The registry has been established for the purpose of quality improvement, using analysis of adverse events for learning. The initiative is owned by the Society for Pediatric Anesthesia, and supported by the participating institutions and by the Anesthesia Patient Safety Foundation. Twenty-four major institutions currently participate with a total case load of approximately 300,000 anesthetics per year. Wake up Safe is designated as a Patient Safety Organization (PSO) by the Agency for Healthcare Research and Quality.

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The Goal of the Initiative is to make Pediatric Anesthesia even safer than it is currently. We will accomplish this goal by learning from analysis of rare, but serious, adverse events, making recommendations about ways to prevent them, and developing Quality Improvements to prevent future events.


Participation is the best way currently available to learn from shared experience in order to reduce the occurrence of serious adverse events and improve care in Pediatric Anesthesia.

You will regularly receive demographic reports about your anesthetic practice and how it compares to all initiative members as a whole.

You will regularly receive reports of your incidence of serious adverse events and a comparison with the group-Fs overall incidence.

-A You will receive expert opinions about steps your institution can take to reduce the incidence of serious adverse events.

Your hospital will participate in Quality Improvement Initiative designed to prevent adverse events.

Your hospital will participate in Peer Reviews of your processes of care.


  1. Approval of the Chair of Anesthesia or other qualified leadership as designated by the institution.
  2. Execute a Participation Agreement with the Society.
  3. Pay the joining fee and yearly fee.
  4. Agree to share de-identified adverse event data as well as demographic data.
  5. Obtain IRB approval for data collection.
  6. Assurance that your individual departmental Quality Improvement data collection process can be coordinated with the methods established by the Wake up Safe initiative. (see below)
  7. Appoint an individual anesthesiologist who will be responsible for your Wake up Safe participation.
  8. Agree to periodic audits of institutional data gathering activities as recommended by the Managers of the Program.
  9. Allocate resources necessary for Quality Improvement Initiatives arising from Wake up Safe. For example this may include safety training for an anesthesiologist and additional FTEs needed for Quality Improvement.
  10. Member anesthesiologists must meet defined responsibilities including completion of the orientation program, attend 50% of meetings, enter data in a timely manner, and continuing education in quality and safety.


One of the requirements for participation in Wake up Safe is the adaptation of your departmental QA processes to conform with those necessary for case finding and review. The following is an outline of those requirements.

Case Identification
Only cases with serious adverse events are to be reported to Wake up Safe so it is unlikely that these cases will not come to the attention of the leadership of the department or the hospital.

There should be several different methods of case identification, including:

  1. Self Report. The department needs to have a clear, well understood method whereby practitioners report cases with adverse events to the department. Self reporting is an important component of professionalism. Adverse event reporting should be mandatory, and should be an important component of individual performance based practice assessment and improvement.
  1. Hospital Risk Management. The department should have a mechanism whereby hospital Risk Management alerts the department when a case involving anesthesia is identified
  1. Hospital Incident Reporting. The department should have a mechanism whereby incidents that are reported to the hospital incident reporting system, and which involve anesthesia, should be reviewed by the anesthesia department.
  1. Surgeon Complaints/concerns. The department should routinely review cases that arise from complaints from surgeons concerning issues involving anesthesia.
  1. Code and Rapid Response Team reports. The department should have a mechanism to review cases that might involve anesthesia arising from cardiorespiratory arrests or rapid response incidents.
  1. Follow-up calls and post op rounds. Information obtained from routine post-operative follow-up should be included in the anesthesia quality assurance process.

Case Review
An important part of the quality assurance process is case review. For cases to be reported to Wake up Safe, there should be a review by at least 3 peer anesthesiologists who were not involved in the case. Input relevant for review of the case, including input from the provider, should be obtained before the case is reviewed. The review is best conducted as a mini root cause analysis, trying to determine the underlying causes or contributing factors of the event.