Pediatric Quality Committee
Morgan L Brown MD PhD
Pediatric Quality Improvement Chair, MPOG
Associate Professor, Harvard Medical School
Clinical Director, Division of Cardiac Anesthesia
Senior Associate, Department of Anesthesiology, Critical Care, and Pain Medicine
Boston Children’s Hospital, Boston, MA
• Introductions
– Name, institution
– Are you a part of MPOG?
– Do you know the QI champion at your institution?
– Are you sending people metrics from MPOG?
– Are you using other metrics?
– E.g. Zofran use, narcotic reconciliation, etc.
Patient Based Blood Management
(1) screening for, diagnosing, and appropriately treating anemia
(2) minimizing surgical, procedural, and iatrogenic blood losses
(3) managing coagulopathic bleeding to improve patient outcomes through patient-
centered care
• Goobie, Faroni 2025 Perioperative paediatric patient blood management: a narrative review
1) To optimize and improve red cell mass by identifying and treating preoperative
anemia at an early stage, thereby preventing unnecessary transfusions
2) To minimize blood loss and maintain the hemostatic balance as effectively as
possible
3) To enhance the patient’s physiological tolerance to anemia and coagulopathy,
ultimately aiming to reduce transfusion requirements
• Acar, Gurocak 2025 Patient blood management in pediatric patients: current strategies and future perspectives.
Who Should We Be Targeting?
Diagnose and treat anemia at least 3–6 weeks before elective surgery (ideally within
an anemia clinic setting). Consider cancelling elective major surgery to optimize
hemoglobin in high-risk patients.
Goobie, Faroni 2025 Perioperative paediatric patient blood management: a narrative review
Major Elective
Surgery in
Pediatrics?
Excluded:
Emergency
Transplants
Burns
Cardiac cases
Age <30 days
Diagnostic imaging
Anesthesia < 60 mins
Surgery < 45 mins
No preop Hb
Rate of Transfusion of PRBC >5%
Tonsillectomy & Adenotonsillectomy
(site data - blinded)
CHEER data – 1.3%
Pain Scores?
Vs.
Opioid Use?
Pain Based Metric?
• What would matter to you & your institution?
• Use existing phenotype:
• Tonsils + Adenotonsils?
• Spine?
• Pain score – peak? Terciles (0-3, 4-6, 7-10?)
• Opioid use – Total? Total in Recovery Room only? Any dose?
Next Meeting
• February 2027?
• Need 2 metric updates
• Volunteers please!
• Looking for feedback about TRAN-06
• Have some data to present on a pain based metric
Chair: morgan.brown@childrens.Harvard.edu
Vice Chair: luboettcher@wisc.edu
