Safe anaesthetic care: further improvements require a focus on resilience

Schnittker, Raphaela; Marshall, Stuart

doi:10.1093/bja/aev153

Cited by 12 publications

(8 citation statements)

References 15 publications

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“…Anaesthesiologists were more inclined to refuse high-risk patients and procedures than the other specialists we included in our study. With its longstanding and strong focus on reducing patient harm, anaesthesiology is seen as the specialism that provides the standard for patient safety 54. Therefore, an explanation for our finding might be that the strong focus on reducing patient harm has translated into a greater emphasis on risk-averse behaviour by anesthesiologists than by those in other specialisms.…”

Section: Discussionmentioning

confidence: 87%

Triggers of defensive medical behaviours: a cross-sectional study among physicians in the Netherlands

et al. 2019

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ObjectivesThis study investigated whether the attitudes of physicians towards justified and unjustified litigation, and their perception of patient pressure in demanding care, influence their use of defensive medical behaviours.DesignCross-sectional survey using exploratory factor analysis was conducted to determine litigation attitude and perceived patient pressure factors. Regression analyses were used to regress these factors on to the ordering of extra tests or procedures (defensive assurance behaviour) or the avoidance of high-risk patients or procedures (defensive avoidance behaviour).SettingData were collected from eight Dutch hospitals.ParticipantsRespondents were 160 physicians and 54 residents (response rate 25%) of the hospital departments of (1) anaesthesiology, (2) colon, stomach and liver diseases, (3) gynaecology, (4) internal medicine, (5) neurology and (6) surgery.Primary outcome measuresRespondents’ application of defensive assurance and avoidance behaviours.Results‘Disapproval of justified litigation’ and ‘Concerns about unjustified litigation’ were positively related to both assurance (β=0.21, p<0.01, and β=0.28, p<0.001, respectively) and avoidance (β=0.16, p<0.05, and β=0.18, p<0.05, respectively) behaviours. ‘Self-blame for justified litigation’ was not significantly related to both defensive behaviours. Perceived patient pressures to refer (β=0.18, p<0.05) and to prescribe medicine (β=0.23, p<0.01) had direct positive relationships with assurance behaviour, whereas perceived patient pressure to prescribe medicine was also positively related to avoidance behaviour (β=0.14, p<0.05). No difference was found between physicians and residents in their defensive medical behaviour.ConclusionsPhysicians adopted more defensive medical behaviours if they had stronger thoughts and emotions towards (un)justified litigation. Further, physicians should be aware that perceived patient pressure for care can lead to them adopting defensive behaviours that negatively affects the quality and safety of patient care.

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Section: Discussionmentioning

confidence: 87%

Triggers of defensive medical behaviours: a cross-sectional study among physicians in the Netherlands

et al. 2019

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“…The interaction between anaesthetic team members and the clinical environment (including technology, physical set-up and other medical team members) enabled successful airway management. This is an important finding that needs to be emphasised: despite awareness of a variety of systemic and equipment factors that can constrain decision making, there is still a tendency to focus on erroneous individual behaviour when there is a poor clinical outcome [5,25].…”

Section: Discussionmentioning

confidence: 99%

“…Proactive management in anaesthesia often lacks visibility due to continuous effective prevention of notable incidents. Safety in anaesthesia can therefore be regarded as a 'dynamic non-event', with proactive management by clinicians constantly contributing to patient safety [5].…”

Section: Introductionmentioning

confidence: 99%

Human factors enablers and barriers for successful airway management – an in‐depth interview study

et al. 2018

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Human factors are the individual, team, environmental and organisational aspects of the anaesthetic environment that affect performance and decision-making of anaesthesia teams. This study aimed to identify which human factors were enablers and/or barriers to anaesthesia teams during airway management challenges. Sixteen interviews were conducted with experienced anaesthetists and anaesthetic nurses using an in-depth interview technique (the Critical Decision Method) to identify human factors enablers and/or barriers during successful management of a significant airway challenge. Thematic analysis identified three overarching enablers: equipment location and storage; experience and learning; teamwork and communication. Five overarching barriers were also identified: time and resource limitations; teamwork and communication; equipment location and storage; experience and learning; insufficient back-up planning; and equipment preparation. This study showed that a variety of human factors issues affect the handling of airway challenges, ranging from individual and team to organisational and environmental aspects. Recommendations for the design of airway management decision support tools that relate to equipment standardisation, decision support complexity, inclusive mutual learning and teamwork are discussed.

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“…Another method of identifying the key decisions and omissions is by interviewing clinicians about emergencies they have been involved in using structured cognitive interviews . Critical Decision Method is one such technique , and can inform broader design and role allocation between team members to strengthen behaviours leading to improved outcomes . Again, this method of design is in its infancy in health with few current examples even outside of anaesthesia to learn from .…”

Section: Which Items To Include?mentioning

confidence: 99%

Helping experts and expert teams perform under duress: an agenda for cognitive aid research

Marshall

2016

Anaesthesia

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Safe anaesthetic care: further improvements require a focus on resilience

Cited by 12 publications

References 15 publications

Triggers of defensive medical behaviours: a cross-sectional study among physicians in the Netherlands

Triggers of defensive medical behaviours: a cross-sectional study among physicians in the Netherlands

Human factors enablers and barriers for successful airway management – an in‐depth interview study

Helping experts and expert teams perform under duress: an agenda for cognitive aid research

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