Communication failures contributing to patient injury in anaesthesia malpractice claims☆

Douglas, Rachel N.; Stephens, Linda S.; Posner, Karen L.; Davies, Joanna M.; Mincer, Shawn L.; Burden, Amanda R.; Domino, Karen B.

doi:10.1016/j.bja.2021.05.030

Cited by 30 publications

(22 citation statements)

References 42 publications

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“…They are designed to reduce human-related errors and thus enhance patient safety [25]. As communication failures can significantly contribute to patient injury and death [2,28], the focus of an anaesthesia pre-induction checklist lies in correct decision-making and preparation for potential anaesthesia-related problems based on clear communicated action plans (i.e. plans A, B, C, D) [29].…”

Section: Discussionmentioning

confidence: 99%

Five‐year audit of adherence to an anaesthesia pre‐induction checklist

et al. 2022

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Although patient safety related to airway management has improved substantially over the last few decades, life-threatening events still occur. Technical skills, clinical expertise and human factors contribute to successful airway management. Checklists aim to improve safety by providing a structured approach to equipment, personnel and decision-making. This audit investigates adherence to our institution's airway checklist from 1 June 2016 to 31 May 2021. Inclusion criteria were procedures requiring airway management and we excluded all procedures performed solely under regional anaesthesia, sedation without airway management or paediatric and cardiovascular surgery. The primary outcome was the proportion of wholly performed preinduction checklists. Secondary outcomes were the pattern of adherence over the 5 years well as details of airway management, including: airway management difficulties; time and location of induction; anaesthesia teams in operating theatres (including teams for different surgical specialities); non-operating theatre and emergency procedures; type of anaesthesia (general or combined); and urgency of the procedure. In total, 95,946 procedures were included. In 57.3%, anaesthesia pre-induction checklists were completed. Over the 5 years after implementation, adherence improved from 48.3% to 66.7% (p < 0.001). Anticipated and unanticipated airway management difficulties (e.g. facemask ventilation, supraglottic airway device or intubation) defined by the handling anaesthetist were encountered in 4.2% of all procedures. Completion of the checklist differed depending on the time of day (61.3% during the day vs. 35.0% during the night, p < 0.001). Completion also differed depending on location (66.8% in operating theatres vs. 41.0% for non-operating theatre anaesthesia, p < 0.001) and urgency of procedure (65.4% in non-emergencies vs. 35.4% in emergencies, p < 0.001). A mixed-effect model indicated that urgency of procedure is a strong predictor for adherence, with emergency cases having lower adherence (OR 0.58, 95%CI 0.49-0.68, p < 0.001). In conclusion, over 5 years, a significant increase in adherence to an anaesthesia pre-induction checklist was found, and areas for further improvement (e.g. emergencies, non-operating room procedures, night-time procedures) were identified.

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Section: Discussionmentioning

confidence: 99%

Five‐year audit of adherence to an anaesthesia pre‐induction checklist

et al. 2022

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“…'Tribes' in the operating room impact patient care; so do gender, race, and ethnicity [24][25][26]. The operating room is an intense work environment in which power imbalances, stereotypes, and unhealthy team dynamics may interact and result in poor communication, tension, and deadly patient outcomes [27,28]. The resulting challenges must be an integral part of thoracic anesthesia training and development.…”

Section: We Learn Together Day After Daymentioning

confidence: 99%

How to train thoracic anesthesia for residents and consultants?

Grande

Kolbe

2021

Current Opinion in Anaesthesiology

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Purpose of reviewThe training of anesthesiologists in thoracic surgery is a significant challenge. International professional societies usually provide only a case number-based or time-based training concept. There are only a few concepts of simulation trainings in thoracic anesthesia and interprofessional debriefings on a daily basis are rarely applied. In this review, we will show how professional curricula should aim for competence rather than number of cases and why simulation-based training and debriefing should be implemented. Recent findingsRecent curricula recommend so-called entrustable professional activities (EPAs)as a way out of the dilemma between the number of cases vs. competence. With these EPAs, competence can be mapped and prerequisites defined. Training concepts from simulation in healthcare have so far not explicitly reached anesthesia for thoracic surgery. In addition to mere technical training, combined technical-behavioral training forms have proven to be an effective training targeting the entire team in the context of the actual working environment in the operating theatre. SummaryInterdisciplinary and interprofessional learning can take place in simulation trainings and on a daily basis through postevent debriefings. When these debriefings are conducted in a structured way, an improvement in the performance of the entire team can be the result. The basis for these debriefings -as well as for other training approaches -is psychological safety, which should be established and maintained together with all professions involved.

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“…According to the review reports of the Anesthesia Closed Claims Project (CCP) database, the leading cause of anesthesia‐related malpractice claims is the breakdown in communication. 14 …”

Section: Introductionmentioning

confidence: 99%

Incidence and factors associated with post‐anesthesia care unit complications in resource‐limited settings: An observational study

Abebe

Kifle

Gunta

et al. 2022

Health Science Reports

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Background and aims: Postoperative complications are frequent encounters in the patients admitted to postanesthesia care units (PACU). The main aim of this study was to assess the incidence of complications and associated factors among surgical patients admitted in limited-resource settings of the PACU.Methods: This is an observational study of 396 surgical patients admitted to PACU.This study was conducted from February 1 to March 30, 2021, in Ethiopia. Study participants' demographics, anesthesia, and surgery-related parameters, PACU complications, and length of stay in PACU were documented. Multivariate and bivariate logistic regression analyses, the odds ratio (OR), and 95% confidence interval (CI) were calculated. p-value < 0.05 was considered as statistically significant.Results: The incidence of complications among surgical patients admitted to PACU was 54.8%. Of these, respiratory-related complications and postoperative nausea/vomiting were the most common types of PACU complications. Being a female (adjusted odds ratio [AOR] = 2.928; 95% CI: 1.899-4.512) was significantly associated with an increased risk of developing PACU complications. Duration of anesthesia >4 h (AOR = 5.406; 95% CI: 2.418-12.088) revealed an increased risk of association with PACU complications. The occurrences of intraoperative complications (AOR = 2.238; 95% CI: 0.991-5.056) during surgery were also associated with PACU complications. Patients who develop PACU complications were strongly associated with length of PACU stay for >4 h (AOR = 2.177; 95% CI: 0.741-6.401). Conclusion:The identified risk factors for complications in surgical patients admitted to PACU are female sex, longer duration of anesthesia, and intraoperative complications occurrences. Patients who developed complications had a long time of stay in PACU. Based on our findings, we recommend the PACU team needs to develop area-specific institutional guidelines and protocols to improve the patients' quality of care and outcomes in PACU.

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Communication failures contributing to patient injury in anaesthesia malpractice claims☆

Cited by 30 publications

References 42 publications

Five‐year audit of adherence to an anaesthesia pre‐induction checklist

Five‐year audit of adherence to an anaesthesia pre‐induction checklist

How to train thoracic anesthesia for residents and consultants?

Incidence and factors associated with post‐anesthesia care unit complications in resource‐limited settings: An observational study

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