From critical incident reporting to safer practice: implementing the LOOP learning framework in paediatric anaesthesia at a tertiary hospital

Balancing patient safety and the need to foster a safe and effective learning environment for trainees remains a core challenge in anaesthesia training programmes. This quality improvement project aimed to evaluate trends in incident rates over time by integrating critical-incident reporting and a conceptual-reflective educational framework. A retrospective observational analysis of audit data on critical incidents in paediatric anaesthesia was conducted from January 2023 to July 2025. The LOOP framework (Look, Observe, Orient and Prepare) was introduced as a routine departmental teaching activity. Incident rates were examined using a time-series summary and regression models to compare rates before and after the framework was introduced. A perception survey of recent trainee cohorts evaluated acceptability, appropriateness and feasibility of the teaching activity. From the 3431 cases in the regression analysis, the post-intervention period saw a lower incident rate (incident rate ratio 0.386; 95% confidence interval 0.220–0.676; p < 0.001) and lower odds of experiencing one or more incidents (odds ratio 0.350; 95% confidence interval 0.206– 0.594; p < 0.001). All 13 eligible trainees responded with mean scores for acceptability (4.55), appropriateness (4.62) and feasibility (4.29) on a five-point Likert scale. Implementation of an educational framework structured around situational awareness was associated with lower critical incident rates. The LOOP framework represents a potentially scalable educational tool for anaesthesia training programmes with relevance to patient safety education.