G. S. P. Panesar, W. Rook

Birmingham Children's Hospital, UK


Anaesthetists are keenly aware of the challenges of managing the anxious child. Children have fears and worries and never more so than when attending hospital for anaesthesia and/or surgery.

It is well established that perioperative anxiety is associated with postoperative disorders such as a difficulty returning to a normal routine, enuresis, apathy and solitary confinement as well as a myriad of subtle behavioural changes [1]


The frameworks for screening, identification and intervention in this group of children are not formally established at our organisation. This leads to fractious on the day management which is not optimal for clinician, patient, or the hospital.

We have sought to develop a standardised framework utilising our valued multi-disciplinary team to improve the perioperative experience for these children, parents and our colleagues.

Strategy for change

Our improvement strategy is based on the ‘4S model’ [scope, shape, shift, sustain] with a Kaizen approach [small incremental improvements]. We have engaged all stakeholders and interested parties, including the local QI team, volunteers, play specialists, our preoperative assessment team and clinicians.

Patients are identified during their preoperative assessment using a modification of a validated screening tool [2] using a digital preoperative assessment system (REMCare) and are stratified into intervention streams based on their reported severity of anxiety. Children and their parents are directed towards either;

Patient information leaflets, videos and a VR journey through our operating theatres

An interactive clinic where they are able to meet anaesthetists, ODPs, play therapists and interact with anaesthetic equipment

A face to face clinic with an anaesthetist

We record patients' anxiety post intervention using an on the day questionnaire to identify effectiveness and refine our process.

Measures of improvement

As the project develops, we hope to demonstrate effective screening for these children and an improvement in their perioperative experience using surveys and questionnaires.

As a secondary measure we aim to survey our colleagues regarding their experience.

Learning to share and message for others


We would like to share the lessons we have learnt establishing this process and the framework that we develop with other centres to progress the holistic management of paediatric anxiety.


  1. Kain ZN Caldwell-Andrews AA Maranets I et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviours. Anesth Analg. 2004; 99: 1648-1654
  2. Chow CH, Van Lieshout RJ, Buckley N, Schmidt LA. Children's Perioperative Multidimensional Anxiety Scale (CPMAS): Development and validation. Psychol Assess. 2016 Sep;28(9):1101-9. doi: 10.1037/pas0000318. PMID: 27537004.


Scroll to top