Patterns of Sevoflurane use in a Children's Hospital: The Effects of a Simple Educational Intervention

Abstract

We conducted a prospective observational study of sevoflurane use over a four-week period at our tertiary referral children's hospital. Sevoflurane vaporisers were weighed before and after all general anaesthesia sessions and anaesthesia time intervals recorded. Midway through the audit, the initial findings were presented to the department with a brief reminder of ways to reduce sevoflurane use. These included recommendations for fresh gas flows and use of alternative agents during maintenance. Sevoflurane use then continued to be audited over a further two-week period. Anaesthesia in induction rooms accounted for 60% of total sevoflurane use but involved only 15% of total general anaesthetic time. Thus sevoflurane was used eight times faster in the induction rooms when compared to operating theatres. There was a 53% reduction in the rate of use of sevoflurane after the educational intervention, with an 87% reduction in in-theatre use and a 31% reduction in induction room use. This represents a potential saving of $108, 120 per annum in our institution. Workloads before and after the educational intervention were comparable. A more complete cost benefit analysis of this initiative would include the costs of alternative agents and any clinical disadvantages incurred and would be seen in the context of the overall health budget. This was beyond the scope of this project. Clinicians can be relatively complacent about financial accountability. In this study, a simple educational reminder halved sevoflurane use in the short term. This study suggests that specific reminders or recommendations about anaesthetic technique in the induction rooms may be indicated.