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
No Relevant Disclosures
32 sites
with
pediatric
data
Pediatric Cardiac Working Group
Developed a pediatric cardiac surgery on cardiopulmonary bypass phenotype
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%
Challenges for Pediatric Quality Committee
• Few data to guide evidence-based practice
• No society/expert opinion based well established quality metrics
• Diverse population with smallish numbers per center
• ages, procedures (lots of CPT codes!), medical diseases
• No standard risk adjustment available
• Desire for more outcomes-based metrics
• Next Goal: Narcotics in PACU metric
Chair: morgan.brown@childrens.Harvard.edu
Vice Chair: luboettcher@wisc.edu