Dr. Anna Varughese Plays It Safe

Pediatric anesthesiologist Anna Varughese, M.D., M.P.H., has been involved with Wake Up Safe since its founding in 2008.

Anna Varughese, M.D., M.P.H.

Anna Varughese, M.D., M.P.H.

Published in Johns Hopkins All Children's Hospital - Spring 2022

Anna Varughese, M.D., M.P.H., was in a Chicago hotel when Wake Up Safe was born.

It was 2008 and a handful of anesthesiologists from the nation’s top children’s hospitals were discussing patient safety. They decided to work together to share data, develop quality measures and analyze the causes of adverse outcomes with the goal to learn and improve perioperative safety.

Today, Wake Up Safe, which is sponsored by the Society for Pediatric Anesthesia, has grown from that handful of children’s hospitals to about 40 members. Johns Hopkins All Children’s Hospital, where Varughese now works as associate chief quality officer, is the only member from Florida.

“It was an incredibly important to create this quality and safety collaborative,” says Varughese, who will serve as president of Wake Up Safe beginning in October. “At its essence, it’s an information sharing and improvement initiative. We have regular monthly conference calls where each institution discusses an improvement project they've undertaken. Each institution has their data benchmarked against other institutions within the collaborative. Wake Up Safe is a patient safety organization with de-identified data for more than 4 million pediatric anesthetic cases.”

Varughese spoke recently about how she embarked on a medical career, developed her focus on patient safety and more.

Did you always want to be a doctor?

I wanted to do medicine from my very early days. Although he was an engineer, my father was always very interested in medicine. The additional advantage I had was my older sister who forged the path in medicine and anesthesiology for me. It has helped tremendously to have supportive parents as well as an older sibling to lead the way into a profession I love.

How did you choose to specialize in pediatric anesthesia?

I was very interested in pediatrics and working with children. I had also worked as a house officer in anesthesia and enjoyed it tremendously. When I realized I could combine pediatrics and anesthesia, that was the “Aha!” moment for me. I enjoy working with children and the intensity of anesthesia, which combines so many disciplines, including medicine, physics, pharmacology and physiology.

Carrying a child safely through an operation is quite a challenging task. There is tremendous immediate gratification when they do well. It’s a privilege taking care of children under anesthesia, because the parents place their trust in you. They have to trust you implicitly to be able to hand their child to you.

How did you gravitate toward the safety and quality area?

In my sixth or seventh year of practice, I wanted to get some additional training in the field of research analytics. I took a three-year master of public health course at the Harvard School of Public Health. One of the core classes was quality improvement and safety. The concepts of safety and improvement science resonated with me. It aligned with my values both personally and professionally. I came back from that first summer and decided safety and quality work was what I wanted to do going forward.

Around the same time, Cincinnati Children’s Hospital Medical Center, where I worked, received a “Pursuing Perfection: Raising the Bar for Health Care Performance” grant from the Robert Wood Johnson Foundation. We embarked on this transformational journey of quality and safety and undertook a systems approach to problem-solving with multiple cross-functional teams working on improving the system. I learned a lot.

Anesthesia has a long history of improving safety. We've come a long way, and our current death rate related to anesthesia is very, very low.

In talking about patient safety, many compare health care to the aviation industry, which made tremendous advances to reduce plane crashes. Can you talk about the benefits and challenges of that analogy?

The aviation industry has done so much work and come so far in terms of safety. There are definitely lessons we in health care can learn from them when it comes to safety. One of the lessons is the use of checklists. We now have a number of checklists in medicine, particularly in the perioperative arena.

That said, we can't just take those lessons, plunk them down in medicine and expect them to work as they do in the aviation industry. People are not planes; they react differently from machines. While standardization of clinical approach is key, customization at the patient level is also very important.

What’s something people might find surprising about you?

I love to dance, so right after my fellowship, I signed up for dance lessons with the Arthur Murray Dance Studio in Cincinnati. Along the way, my instructor decided that another student and I would be a good fit. He was right. That student is now my husband and we have been married for over 20 years. We are fortunate to have a wonderful son and daughter-in-law and now a precious new grandson who spent a few months in a level IV NICU recently. He is now home and moving from strength to strength. We are so grateful and thankful for that!