Supplemental Table 1: Wake Up Safe event definitions
Event type Subtype Wake up Safe Definition
Death Death within 24 hours after induction of anesthesia
Cardiac Arrest Cessation of cardiac mechanical activity as confirmed by the absence of signs of circulation. (Use of cardiac compressions and/or
defibrillation). During the first 48 hours after induction of anesthesia Acute Lung Injury Unanticipated new onset of impaired gas exchange associated with
parenchymal lung injury. Severity of impairment of gas exchange is shown by post-operative mechanical ventilation or by reintubation, defined as placement of tracheal tube or other airway devices and mechanical or assisted ventilation within 6 hours after extubation because of severe respiratory distress, hypoxia, hypercapnia, or respiratory acidosis. This new impairment occurs following an operation in which postoperative mechanical ventilation is not anticipated.
Acute Cardiovascular
Deterioration Unanticipated need for postoperative cardiovascular support, such as vasopressors or ECMO. In general the operative procedure is one in which the use of cardiovascular support is rarely or never needed because of the procedure itself
Tissue Injury Musculoskeletal
injury Soft tissue or muscle injury that occurs in the perioperative period and requires ongoing treatment or surgical intervention (includes IV
infiltration)
Skin Injury Burns or other skin injury that require ongoing treatment or surgical intervention is required.
Bone or joint injury Injury to bones or joints related to anesthesia or patient positioning.
Severity of injury is such that ongoing treatment or surgical intervention is required.
Nervous system injury Brain Injury Injury to brain related to anesthesia resulting in neurologic signs or symptoms. Findings are not an anticipated result of surgical procedure
Spinal cord injury Injury to spinal cord related to anesthesia resulting in neurologic signs or symptoms. Findings are not an anticipated result of surgical
procedure
Nerve injury Peripheral nerve injury resulting in ongoing numbness, pain or other symptom, related to general or regional anesthesia or patient
positioning. Findings are not an anticipated result of surgical procedure
Peripheral neurologic deficit following regional anesthesia
Clinical diagnosis of residual sensory and /or motor and /or autonomic block 72 hours after last injection of local anesthetic without other identifiable etiology when no regional analgesia related infection is present
Eye injury Eye injury Injury to eye or visual system (other than corneal abrasion that resolves in 24 hours)
Anaphylaxis Anaphylaxis Clinical diagnosis of a severe, life-threatening allergic response, characterized by sudden drop in blood pressure, especially if epinephrine is administered, and/or respiratory insufficiency.
Malignant
Hyperthermia Malignant
Hyperthermia Clinical diagnosis of suspected MH during or after exposure to anesthetic gases or succinylcholine or treatment with dantrolene.
Airway Injury Injury to Pharynx, larynx, trachea or lungs not a result of underlying disease
Airway Management Injury to patient as a result of problems in establishing or maintaining an open airway
Equipment Issues Injury to patient as a result of malfunction of equipment or as a result of unavailability of equipment that would be consider a standard of care
Sentinel Event
Surgery or
anesthesia on the wrong body part
Surgery or anesthesia (defined as induction of anesthesia) (including regional nerve block) on the wrong body part or the wrong side of the patient.
Surgery or
anesthesia on the wrong patient
Surgery or anesthesia (defined as induction of anesthesia) on the wrong patient
Fire Spark or flame in the OR resulting in patient injury or damage to surgical supplies or equipment including surgical drapes
Awareness under
anesthesia Patient becomes conscious during a procedure performed under general anesthesia and subsequently has recall of these events.
Medication Error Wrong drug, wrong patient, infusion error or administration of drug that patient is known to be allergic to, resulting in need for ongoing care, not a result of underlying disease
Transfusion reaction Clinical diagnosis of definite or suspected transfusion reaction during or following transfusion of blood products confirmed by blood bank results to be possibly incompatible with patient blood. New onset of fever, chills, rash, flank pain or back pain, bloody urine, fainting or dizziness, kidney failure, delayed anemia, lung dysfunction or shock.