Making Pediatric
Anesthesia Even Safer


Wake Up Safe, with the Society for Pediatric Anesthesia as its sponsor, is dedicated to better outcomes for children receiving anesthetic care and to the education of our members in improvement science. Wake Up Safe, through the efforts of its members, collects data on thousands of anesthetic patients each year. Members have access to this data and to monthly conference calls and twice-yearly meetings which promote the dissemination of best practices. Members have used the database to publish numerous papers in peer reviewed journals. Wake Up Safe has been certified by the Agency for Healthcare Research and Quality (AHRQ) as a Patient Safety Organization.

Join Wake Up Safe

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. Thirty-four major institutions currently participate with a total case load of approximately 500,000 anesthetics per year. Wake up Safe is designated as a Patient Safety Organization (PSO) by the Agency for Healthcare Research and Quality.

Select Membership Topic

  • Reasons to Join Wake Up Safe
  • Participating Institutions
  • Benefits of Participation
  • Requirements for Participation
  • Guidelines for Quality Assurance Process for Wake Up Safe Participants
  • Case Review
  • Goal

    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.

  • Reasons to Join Wake Up Safe

    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 have access to demographic reports about your anesthetic practice and how it compares to all initiative members as a whole. You have access to reports of your incidence of serious adverse events and a comparison with the group’s overall incidence. 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.

  • Participating Institutions

    • Akron Children’s Hospital
    • Ann and Robert H. Lurie Children’s Hospital of Chicago
    • Arkansas Children’s Hospital
    • Buffalo Children’s Hospital
    • Cardinal Glennon Children’s Hospital, St. Louis, MO
    • Children’s Hospital Boston
    • Children’s Hospital Los Angeles
    • Children’s Hospitals and Clinics of Minnesota
    • Children’s Hospital of Omaha
    • The Children’s Hospital of Philadelphia
    • Children’s Hospital of Pittsburgh
    • Children’s Medical Center, Dallas, TX
    • Children’s National Medical Center, Washington DC
    • Cleveland Clinic Children’s Hospital
    • Cincinnati Children’s Hospital Medical Center
    • Colorado Children’s Hospital
    • Cook Children’s Hospital
    • Dayton Children’s Hospital
    • Dell Children’s Medical Center
    • Emory Children’s Center
    • Johns Hopkins All Children’s Hospital
    • Johns Hopkins Children’s Center
    • Kaiser Oakland Medical Center
    • Lucile Salter Packard Children’s Hospital at Stanford
    • Medical University of South Carolina
    • Montefiore Children’s Hospital
    • Monroe Carell Jr Children’s Hospital at Vanderbilt
    • Morgan Stanley Children’s Hospital of Columbia University Medical Center
    • Nationwide Children’s Hospital
    • Nemours/Alfred I DuPont Hospital for Children
    • Penn State Hershey Children’s Center
    • Phoenix Children’s Hospital
    • Riley Children’s Hospital
    • Seattle Children’s Hospital
    • St. Jude Children’s Research Hospital
    • Texas Children’s Hospital
    • University of Iowa Stead Family Children’s Hospital
    • University of Michigan C. S. Mott Children’s Hospital
    • US Anesthesia Partners
  • Benefits of Participation

    • Demographic profile of perioperative cases by age, specialty, and physical status of child and comparison with average of group.
    • Report of occurrence of serious adverse events and comparison with group averages.
    • Root causes of serious events for your hospital and compilation of root causes of events for the group of participating hospitals.
    • Recommendations for prevention of the serious adverse events.
    • Education sessions to learn Safety Analytics and Quality Improvements methodology.
    • Participation in Quality Improvement Initiatives.
    • Participation in Peer Evaluation Initiatives.
  • Requirements for Participation

    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.
  • Guidelines for Quality Assurance Process for Wake Up Safe Participants

    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.
    2. Hospital Risk Management. The department should have a mechanism whereby hospital Risk Management alerts the department when a case involving anesthesia is identified
    3. 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.
    4. Surgeon Complaints/concerns. The department should routinely review cases that arise from complaints from surgeons concerning issues involving anesthesia.
    5. 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.
    6. 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.

We are an AHRQ designated Patient Safety Organization

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

Resources for Wake up Safe Members


Dekker, Sidney:

The Field Guide to Understanding Human Error
Ashgate Publishing, Burlington VT

Institute of Medicine:

To Err is Human: Building a Safer Health System
National Academy Press, Washington DC

Reason, James:

Managing the Risks of Organizational Accidents
Ashgate Publishing, Burlington VT

Reason, James:

Human Error
Cambridge University Press, New York

Wheeler, Donald:

Understanding Variation: the key to managing chaos
SPC press

Langely GJ, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP:

The Improvement Guide: a practical approach to enhancing organizational performance
Jossey-Bass, San Francisco

Weick, K and Sutcliffe, K:

Managing the Unexpected
Jossey-Bass, San Francisco

Nance, John:

Why Hospitals Should Fly
Second River Healthcare Press, Bozeman MT

Christensen, Clayton:

The Innovator's Prescription: a disruptive solution for health care
McGraw-Hill, New York

Michelli, Joseph:

Prescription for Excellence
McGraw-Hill, New York


Pratap JN, Varughese AM, Kurth CD, Adler E:

Getting started with the model for improvement: introduction and understanding variation.
Br J Hosp Med (Lond). 2012, Dec;73(12):701-5

Pratap JN, Varughese AM, Adler E, Kurth CD:

Getting started with the model for improvement: the model in practice.
Br J Hosp Med (Lond). 2013 Jan;74(1):42-6

Pratap JN, Varughese AM, Adler E, Kurth CD:

Getting started with the model for improvement: psychology and leadership in quality improvement.
Br J Hosp Med (Lond). 2013 Feb;74(2):104-8

Hudson DW, Holzmueller CG, Pronovost PJ, Gianci SJ, Pate ZT, Wahr J, Heitmiller ES, Thompson DA, Martinez EA, Marsteller JA, Gurses AP, Lubomski LH, Goeschel CA, Pham JC:

Toward improving patient safety through voluntary peer-to-peer assessment.
Am J Med Qual. 2012 May-Jun;27(3):201-9

Case and Data Entry Website Links

Axio Case Entry