Nagelhout Chapter 59 Flashcards
What factors have contributed to the decline in anesthesia-related mortality?
Better monitoring techniques, enhanced understanding of anesthesia risks, improved airway management, and knowledge sharing among professionals.
What is the range of anesthesia-related mortality rates depending on classification?
Anesthesia-related mortality rates can range from 0.8% to 34% of all surgical deaths.
What are key risk factors associated with anesthesia mortality?
Poor patient health (ASA status 3-5), lack of standardized protocols, high-risk procedures or emergencies, and failures in communication between care providers.
What are some factors contributing to anesthesia-related mortality?
Patient comorbidities, data limitations, outpatient procedures, and death being the leading cause of anesthesia malpractice claims.
What does morbidity refer to in the context of anesthesia?
Morbidity refers to disease, injury, or health complications arising during the perioperative period.
What are the most common causes of anesthesia-related injury?
Nerve damage due to regional blocks (20%).
What are the rising trends in anesthesia-related morbidity claims?
Acute pain management issues (8%), obstetric anesthesia claims (8% to 25%), and monitored anesthesia care claims (2% to 10%).
What are the key causes of increased anesthesia morbidity?
Respiratory complications (17%), cardiovascular issues (13%), and equipment failures (10%).
What is minor morbidity?
Moderate distress without prolonging hospital stay and no permanent complications (e.g., postoperative nausea and vomiting).
What is intermediate morbidity?
Serious distress prolonging hospital stay or both, with no permanent complications (e.g., dental injury).
What is major morbidity?
Permanent disability or complication (e.g., spinal cord injury; anoxic brain injury).
What factors have contributed to the increase in chronic pain claims?
Lack of standardized pain management protocols, inadequate patient monitoring, and higher reliance on outpatient and ambulatory surgical settings.
What percentage of anesthesia-related deaths is attributed to human error?
Human error is responsible for 51% to 77% of anesthesia-related deaths.
What are the leading causes of adverse surgical outcomes?
Errors in teamwork and communication contribute to 43% to 65% of sentinel events in the operating room.
What are common human errors in the perioperative setting?
Common human errors include wrong site/surgery, medication errors, transfusion errors, and communication failures.
What percentage of oral miscommunication occurs in the operating room?
Oral miscommunication accounts for 36% of communication failures.
What is the estimated frequency of drug administration errors in anesthesia?
The frequency of drug errors is estimated to be 1 in every 113 to 450 anesthetics administered.
What is the impact of human factors on perioperative care?
Human factors related to perioperative care significantly contribute to morbidity and mortality.
What is the rank of anesthetic complications in pregnancy-related mortality in the U.S.?
Anesthetic complications are the seventh leading cause of pregnancy-related mortality, accounting for 1.6% of all pregnancy-related deaths.
How much higher is the risk of death from general anesthesia compared to neuraxial anesthesia?
Parturients are 17 times more likely to die from general anesthesia complications compared to neuraxial techniques.
What were the major causes of anesthesia-related maternal deaths in a Michigan study?
Most deaths occurred due to airway obstruction or hypoventilation during emergence and recovery.
What role do system errors play in maternal anesthesia-related deaths?
System errors include lapses in postoperative monitoring and missed diagnoses.
What are high-risk factors for maternal anesthesia-related deaths?
High-risk factors include obesity and being of African descent.
What percentage of obstetric anesthesia malpractice claims involved neonatal death or severe brain damage?
20% of cases involved neonatal death or severe brain damage due to ‘Good Samaritan’ resuscitation interventions.
What percentage of malpractice claims were for maternal injuries?
71% of claims were for maternal injuries.
What factors are associated with anesthesia-related neonatal outcomes?
Factors include anesthesia delays, miscommunication regarding urgency, inappropriate choice of anesthesia, and maternal hypoxia. High/total spinal block causing maternal and fetal hypoxia.
What is the significance of the 30-minute decision-to-incision time for emergency cesarean sections?
Failure to meet this time plays a role in medical malpractice cases.
What are the most commonly cited procedures in closed malpractice claims (2000-2012)?
Cervical injections (44%), lumbar injections (29%), device implantation, maintenance, or removal (27%).
What does a high number of malpractice claims in cervical procedures suggest?
It suggests a need for safer, more effective strategies.
What are the top five predictors of 30-day mortality in elderly patients?
- ASA physical status
- Preoperative plasma albumin levels
- Emergency surgery
- Preoperative functional status
- Preoperative renal impairment.
What does a higher ASA score indicate?
It increases mortality risk.
What percentage of elderly patients died within 30 days post-surgery in the REASON Study?
1 in 20 (5%).
What percentage of elderly patients experienced at least one major complication in the REASON Study?
1 in 5 (20%).
What are the key risk factors identified in the REASON Study?
Age, ASA physical status, albumin levels, emergency surgery.
What is the 30-day mortality rate for patients aged 70 with ASA 1-2?
1%.
How does the mortality risk change for patients aged 80-89 compared to those in their 70s?
They have 2x the risk of mortality.
What is the mortality risk for patients aged 90+ compared to those in their 70s?
They have 4x the risk.
Why is frailty important in anesthesia risk?
It is emerging as a critical predictor of postoperative complications.
What are the five frailty domains?
- Age
- Sex
- Comorbidities
- Physical status
- Type of surgery.
What is the risk of complications for patients with intermediate frailty (2-3 domains)?
It doubles the risk of complications.
What is the risk of complications for frail patients (4-5 domains)?
They have a 2.5x greater risk of complications.
What are the two primary types of cognitive dysfunction?
Postoperative Cognitive Dysfunction (POCD) and Delirium.
What is the incidence of delirium in hospitalized elderly patients?
20% incidence in hospitalized elderly patients.
What is the incidence of delirium in sedated ICU patients?
80% incidence in sedated ICU patients.
What are the consequences of delirium?
Delirium is independently linked to longer hospital stays and higher mortality.
What factors can reduce delirium according to recent studies?
Optimizing pain control, managing depth of anesthesia, using regional anesthesia, maintaining oxygenation, avoiding polypharmacy, and using acetaminophen with opioids.
What concerns exist regarding pediatric brain growth and anesthesia?
Prolonged or multiple anesthetic exposures in young children have been linked to developmental delays.
What are the effects of anesthetic exposure during critical brain development periods?
Widespread neuronal apoptosis and functional deficits later in life.
What key anesthetic agents are implicated in pediatric cognitive dysfunction?
N-methyl-D-aspartate (NMDA) receptor antagonists and gamma-aminobutyric acid (GABA) agonists.
Is there a definitive ‘safe dose’ or ‘safe duration’ for anesthetic agents?
No definitive ‘safe dose’ or ‘safe duration’ for these agents has been identified.
What did studies on nonhuman primates reveal about ketamine exposure?
Shorter ketamine exposure (3 hours) did not produce significant effects.
What was the result of isoflurane exposure on postnatal day 6?
Isoflurane exposure resulted in neuroapoptosis.
What correlation exists between surgery and developmental delays in children?
Children who had surgery were twice as likely to have developmental delays or behavioral disorders.
What did the 2011 retrospective study find regarding learning disabilities and anesthesia exposure?
Single anesthetic exposure showed no increased risk, while two or more exposures significantly increased the risk.
How does cumulative anesthesia exposure relate to cognitive impairments?
Increased cumulative anesthesia exposure correlated with higher risk of cognitive impairments.
What challenges do adults with congenital heart disease (CHD) face during surgery?
Higher perioperative morbidity and mortality compared to non-CHD patients.
What percentage of damaging events in noncardiac surgeries occurred outside the operating room?
Over half of damaging events occurred outside the operating room.
What percentage of adverse events were directly related to CHD?
Less than half (48%) of all adverse events were directly related to CHD.
What types of surgeries accounted for CHD-related adverse events?
Cardiac surgeries accounted for over half of all CHD-related adverse events, with noncardiac procedures also contributing.
What are contributing factors to poor outcomes in CHD patients?
Anesthetic complications and lack of CHD expertise were major contributors.
What is the prevalence of intraoperative cardiac arrest during anesthesia?
Cardiac arrest during anesthesia is usually a concomitant event rather than a direct cause.
What are the incidence rates of cardiac arrest in adults and children?
Adults: 0.2 to 1.1 per 10,000 cases. Children: 1.4 to 2.9 per 10,000 cases.
Which group is at higher risk for cardiac arrest?
Patients aged 51-70 years with ASA physical status 3 and 4.
What percentage of cardiac arrest cases are males?
Males account for 61% of cases.
What is the incidence of cardiac arrest with neuraxial anesthesia compared to general anesthesia?
Neuraxial anesthesia has a lower incidence of cardiac arrest (0.04 - 1.8 per 10,000 cases) compared to general anesthesia.
What are the causes of intraoperative cardiac arrest?
Preoperative patient complications (65%), surgical procedure-related complications (24%), intraoperative pathological events (9%), and anesthetic management-related complications (2%).
What are major factors contributing to cardiac arrest?
Excessive surgical bleeding (seen in 70% of surgical deaths) and anesthesia-related complications.
What are some anesthesia-related complications?
Myocardial infarction, hypotension, ST-segment depression, bradycardia, ventricular fibrillation, and myocarditis.
What is the anesthesia-related cardiac arrest mortality rate?
70% (same as non-anesthesia-related perioperative cardiac arrests).
What are the underlying causes of cardiac arrest?
Pre-existing comorbidities, poor risk assessment, inappropriate anesthetic management, human error, and clinical misjudgment.
What are the key concerns with supraglottic devices?
Airway mortality occurs due to failure to ventilate, not failure to intubate.
What challenges exist in evaluating airway management?
Severe airway-related adverse events are rare, difficult mask ventilation occurs in 1.4% of cases, and impossible mask ventilation occurs in 0.2% of cases.
What are common supraglottic devices used for difficult airways?
Classic Laryngeal Mask Airway (cLMA) and Intubating LMA (97% to 100% success rate).
What are some other supraglottic devices?
LMA ProSeal, Supreme LMA, i-gel, Ambu Aura-I, air-Q intubating laryngeal airways, Cobra perilaryngeal airway, Cobra-PLUS, and Laryngeal Tube.
What are complications associated with supraglottic devices?
Inadequate seal, induced laryngospasm, aspiration of gastric contents, failed placement (1-5% of cases), cuff overfilling leading to tissue trauma, dislodgment of the device, insertion trauma, and insufficient depth of anesthesia at the time of insertion.
What is Endotracheal Intubation?
A medical procedure to place a tube into the trachea to maintain an open airway.
What is a high-risk scenario in airway management?
“Cannot Intubate, Cannot Ventilate” is a serious but infrequent challenge that increases anesthetic risk.
What is the link between difficult intubation and traumatic intubation?
Difficult intubation is closely linked to traumatic intubation.
What percentage of airway-related closed claims involved difficult intubation?
27% of airway-related closed claims involved difficult intubation.
What are the outcomes of injuries related to difficult intubation?
87% of injuries were temporary, while 8% resulted in death.
What percentage of airway injury claims involved failure to meet the standard of care?
21% of airway injury claims involved failure to meet the standard of care.
When do most difficult intubations occur?
67% of difficult intubations occur at the induction of general anesthesia and are often unanticipated.
What is essential for effective airway management?
Airway management must include backup plans that are as detailed as the primary airway plan.
What can happen if a failing airway plan is not recognized?
Failure to recognize a failing airway plan can lead to rapid deterioration.
What is critical during airway management?
Good communication among the anesthesia team is critical.
What is the gold standard for elective difficult airway management?
Fiberoptic intubation of the spontaneously breathing patient remains the gold standard.
What are the advantages of fiberoptic techniques?
Fiberoptic techniques allow greater control and visualization and are preferred for anticipated difficult airways.
What is video laryngoscopy?
A widely available alternative to fiberoptic intubation that provides better visualization of the airway.
What are the limitations of video laryngoscopy?
Primarily designed for orotracheal intubation and requires some degree of mouth opening.
What are potential complications of video laryngoscopy?
Pharyngeal mucosal perforation, trauma from rigid stylet use, and blind spots in the oropharynx.
How can complications during intubation be minimized?
Increased vigilance, direct visual observation during tube passage, and avoiding excessive force.
What is the role of Sugammadex in difficult airway management?
Sugammadex is a neuromuscular blockade reversal agent valuable in ‘cannot intubate, cannot ventilate’ scenarios.
What are the benefits of early administration of Sugammadex?
It may prevent prolonged apnea and improve patient outcomes.
Can Sugammadex reverse adverse effects after prolonged apnea?
Even after 5 minutes of apnea and multiple failed intubation attempts, it may not always reverse the adverse effects completely.
What are the hemodynamic and anatomic risks of endotracheal intubation?
Endotracheal intubation can lead to both physiologic effects and anatomical injuries.
What are common complications of endotracheal intubation?
Dental trauma (50%), sore throat (40%), laryngeal trauma (6.2%), granulation tissue formation, and vocal cord paralysis.
What can help prevent long-term supraglottic complications?
Early tracheostomy may help prevent complications associated with prolonged intubation.
What is intraoperative awareness with explicit recall?
It occurs in 1 to 2 per 1000 patients undergoing general surgery when assessed using the Brice methodology/questionnaire.
What are high-risk surgical cases for intraoperative awareness?
Certain procedures carry a 10 times higher risk of awareness, with an incidence of 1 in 100 cases. High-risk categories include trauma surgery, obstetric procedures (e.g., emergency cesarean sections), and cardiovascular surgery (e.g., cardiac bypass surgery).
What are physiological indicators of intraoperative awareness?
Patient movement is noted in 1 of every 7 awareness cases. Tachycardia and hypertension develop in about 1 in every 5 cases of intraoperative awareness.
What are common patient experiences during MAC awareness?
Patients may hear conversations in the operating room, remember bright lights and the operating room setting, and feel distress due to expectations of complete unconsciousness not being met.
What are the implications for MAC awareness?
Patients should be counseled preoperatively about what to expect during procedures with MAC to minimize distress.
What can failure to align expectations during MAC lead to?
It may lead to posttraumatic stress disorder (PTSD), fear of future surgeries, and increased medicolegal risks.
What percentage of patients who experienced intraoperative awareness developed PTSD?
71% of patients who experienced intraoperative awareness developed PTSD.
What were the strongest predictors of PTSD in patients with intraoperative awareness?
Emotional distress and the experience of paralysis.
What are postoperative symptoms related to awareness and PTSD?
Postoperative symptoms include sleep disturbances (19%), nightmares (21%), fear of future anesthetics (20%), and daytime anxiety (17%).
What percentage of fatal or permanent brain damage cases due to opioid-related respiratory depression were preventable?
97% of cases were considered preventable with better monitoring and surveillance.
Who are patients at higher risk for opioid-induced respiratory depression?
Patients at higher risk include those with obstructive sleep apnea (OSA), elderly individuals (age > 50 years), premature infants (<60 weeks postconceptual age), patients with renal, cardiac, or pulmonary disease (e.g., COPD), obese patients (66% of reported cases), females (57%), ASA Physical Status 1 & 2 (63%), and patients undergoing lower extremity surgery (41%).
What are opioid-specific risk factors?
Morphine has active metabolites (morphine-6-glucuronide), which can accumulate, especially in patients with renal dysfunction. Hydromorphone has a delayed onset, increasing the risk of overdosing when using patient-controlled analgesia (PCA).
What are prevention strategies for opioid-induced respiratory depression?
Close monitoring using pulse oximetry combined with CO₂ monitoring and respiratory rate tracking can provide early warning signs of impending respiratory depression. Avoiding over-sedation in high-risk populations and titrating opioids carefully while considering multimodal pain management strategies.
What is intraoperative awareness with explicit recall?
It occurs in 1 to 2 per 1000 patients undergoing general surgery when assessed using the Brice methodology/questionnaire.
What are high-risk surgical cases for intraoperative awareness?
Certain procedures carry a 10 times higher risk of awareness, with an incidence of 1 in 100 cases. High-risk categories include trauma surgery, obstetric procedures (e.g., emergency cesarean sections), and cardiovascular surgery (e.g., cardiac bypass surgery).
What are physiological indicators of intraoperative awareness?
Patient movement is noted in 1 of every 7 awareness cases. Tachycardia and hypertension develop in about 1 in every 5 cases of intraoperative awareness.
What are common patient experiences during MAC awareness?
Patients may hear conversations in the operating room, remember bright lights and the operating room setting, and feel distress due to expectations of complete unconsciousness not being met.
What are the implications for MAC awareness?
Patients should be counseled preoperatively about what to expect during procedures with MAC to minimize distress.
What can failure to align expectations during MAC lead to?
It may lead to posttraumatic stress disorder (PTSD), fear of future surgeries, and increased medicolegal risks.
What percentage of patients who experienced intraoperative awareness developed PTSD?
71% of patients who experienced intraoperative awareness developed PTSD.
What were the strongest predictors of PTSD in patients with intraoperative awareness?
Emotional distress and the experience of paralysis.
What are postoperative symptoms related to awareness and PTSD?
Postoperative symptoms include sleep disturbances (19%), nightmares (21%), fear of future anesthetics (20%), and daytime anxiety (17%).
What percentage of fatal or permanent brain damage cases due to opioid-related respiratory depression were preventable?
97% of cases were considered preventable with better monitoring and surveillance.
Who are patients at higher risk for opioid-induced respiratory depression?
Patients at higher risk include those with obstructive sleep apnea (OSA), elderly individuals (age > 50 years), premature infants (<60 weeks postconceptual age), patients with renal, cardiac, or pulmonary disease (e.g., COPD), obese patients (66% of reported cases), females (57%), ASA Physical Status 1 & 2 (63%), and patients undergoing lower extremity surgery (41%).
What are opioid-specific risk factors?
Morphine has active metabolites (morphine-6-glucuronide), which can accumulate, especially in patients with renal dysfunction. Hydromorphone has a delayed onset, increasing the risk of overdosing when using patient-controlled analgesia (PCA).
What are prevention strategies for opioid-induced respiratory depression?
Close monitoring using pulse oximetry combined with CO₂ monitoring and respiratory rate tracking can provide early warning signs of impending respiratory depression. Avoiding over-sedation in high-risk populations and titrating opioids carefully while considering multimodal pain management strategies.
Risk Factors for Awareness
• Female sex
• Age (younger adults, but not children)
• Obesity
• Clinician experience
• Previous awareness
• After normal hours operations
- Emergency procedures
- Type of surgery (obstetric, cardiac, thoracic)
• Use of nondepolarizing relaxants
What is the trend in the use of anesthesia outside the operating room?
The use of anesthesia outside the traditional operating room setting is expanding.
What percentage of endoscopy patients receive sedation from nurses?
79% of endoscopy patients receive sedation administered by nurses under gastroenterologist supervision.
What percentage of sedations are performed by anesthesia providers?
Only 29% of sedations were performed by anesthesia providers.
What percentage of deaths in non-operating room anesthesia are due to respiratory depression?
44% of deaths in non-operating room anesthesia were due to respiratory depression.
What accounted for over one-third of reported cases in anesthesia?
Polypharmacy (propofol combined with other sedatives or analgesics) accounted for over one-third of reported cases.
What percentage of cases where oversedation occurred used capnography monitoring?
Capnography monitoring was used in only 15% of cases where oversedation occurred.
What are some prevention strategies for anesthesia complications?
Improved respiratory monitoring, limiting polypharmacy combinations, and ensuring trained anesthesia personnel manage high-risk patients.
What is the purpose of shared decision-making in anesthesia care?
Shared decision-making allows patients to be actively involved in their anesthesia care decisions, improving satisfaction, safety, and outcomes.
What do patients consider important factors in anesthesia care quality?
Respect for individual preferences and high-quality education about anesthesia options.
What can decision aids enhance in patient care?
Decision aids can enhance patient knowledge, improve risk perception, and lead to better alignment of choices with patient values.
What is a critical incident in patient care?
An undesirable event during patient care that could have led to harm.
What is an adverse event in medical management?
An unintended patient injury due to medical management, leading to prolonged hospitalization, disability post-discharge, or death.
What support do patients and families require after critical incidents?
Patients and families require support after critical incidents.
What psychological effects may healthcare professionals experience after medical errors?
Healthcare professionals may experience psychological distress following medical errors.
What is Root Cause Analysis (RCA)?
A method used to identify underlying causes of complications, helping prevent future occurrences by improving systems.
What are the immediate steps when a critical incident occurs in anesthesia?
Patient protection and care continuation, securing evidence, team debriefing, communication assignment, incident analysis, and formal reporting.
What is the primary responsibility of the provider during a critical incident?
To ensure the patient’s safety by continuing appropriate care and preventing further harm.
What common emotional responses do nurse anesthetists experience after critical incidents?
Common responses include reliving the event (72%), guilt (70%), and anxiety (67%).
What is the Root Cause Analysis (RCA) process?
A retrospective investigation to determine contributing factors and prevent future occurrences, based on the principle that incidents arise from systemic failures.
What is the first step in the RCA process?
Identifying the Incident - Clearly define the problem statement related to the event.
What is the purpose of forming a multidisciplinary team in RCA?
To assemble a diverse group of professionals to conduct the RCA.
What does process examination involve in RCA?
Understanding workflows and organizational processes that contributed to the event.
What is involved in data collection during RCA?
Gathering factual accounts, written statements, and any available documentation from those involved.
What is the evidence review step in RCA?
Searching medical literature and databases for relevant, high-quality evidence related to the event.
What technique is used for brainstorming possible causes in RCA?
Using structured questioning, such as the ‘Why?’ method, to identify direct and indirect contributing factors.
What does data analysis entail in the RCA process?
Evaluating collected information using logic trees and other analytical tools to validate causal theories.
What is the goal of proposing corrective actions in RCA?
Developing multiple solutions rather than settling on a single quick fix.
What is included in formal report preparation for RCA?
Creating a structured, factual report devoid of emotional bias or blame.
What is the purpose of reevaluating actions taken in RCA?
Monitoring whether the implemented solutions effectively prevent recurrence.
What is a key principle of RCA?
Blame avoidance, which shifts focus from individuals to systemic improvements.
What is open disclosure in incident reporting?
Transparent communication with patients and families following a critical incident.
What should open disclosure include?
Accurate Information, Immediate Consequences & Actions Taken, Expression of Regret, and Prevention Measures.
What are the consequences of withholding information from patients?
Leads to lower patient trust, dissatisfaction, and emotional distress.
What is a second victim in healthcare?
A healthcare provider involved in an adverse event who suffers emotional and psychological distress.
What feelings do second victims often experience?
Guilt, anxiety, self-doubt, PTSD, sleep disturbances, and burnout.
What is the risk associated with second victims?
Increased risk of making future medical errors due to emotional turmoil.
What fears do second victims face?
Fear of reputation loss, institutional consequences, and litigation.
How long does recovery last for second victims?
Recovery lasts for several months.
What are the stages of recovery for second victims?
- Chaos/accident response
- Intrusive reflections
- Restoring personal integrity
- Enduring inquisition
- Obtaining emotional first aid
- Moving onward
What is meant by ‘Chaos & Realization’?
Confusion and emotional turmoil immediately after the event.
What are ‘Haunted Reenactments’?
Repetitive ‘what if’ scenarios and self-doubt.
What does ‘Seeking Support’ involve?
Turning to colleagues, friends, or family for reassurance.
What is the ‘Fear of Institutional Ramifications’?
Worrying about disciplinary actions and professional consequences.
When should one seek legal and professional advice?
Consulting attorneys or hospital administrators if litigation is a concern.
What are the possible final outcomes for a provider after an event?
The provider either drops out, survives, or thrives.
What are some emotional and professional needs after an incident?
- Talking to someone
- Validation of decision-making
- Reaffirmation of competence
- Personal reassurance
What is the impact of lack of institutional support?
It prolongs emotional distress.
Who are often the primary sources of emotional relief?
Colleagues and mentors.
Why is legal and administrative guidance necessary?
In cases of potential litigation.
What do human factors refer to?
The ways in which human performance and behavior interact with the surrounding environment.
What percentage of anesthesia-related deaths involve human factors?
51% to 77%.
What percentage of errors result from lack of experience or competence?
89%.
What percentage of errors are due to errors in judgment or analysis?
11%.
Are errors always intrinsically bad?
In reality, errors are part of the learning process and essential for adapting to new situations.
Can highly skilled individuals make severe mistakes?
Yes, they can make severe mistakes under stress.
Are errors random?
They are often predictable and follow patterns that can be managed.
What are the types of errors in healthcare?
- Slips and Memory Lapses
- Rule-Based Errors
What are ‘Slips and Memory Lapses’?
When actions don’t go as planned, such as forgetting a critical step in a procedure.
What are ‘Rule-Based Errors’?
Errors when clinicians apply a correct rule in the wrong context, use a wrong rule in a familiar situation, or fail to apply a necessary rule.
What increases the likelihood of errors?
When individuals are unsure of what they are doing, highlighting the need for structured training and support systems.
What is the new perspective on human error in healthcare?
Human error analysis should be a starting point for system improvement, rather than blaming individuals.
Why is human error unavoidable in healthcare?
Healthcare is a complex system that requires flexibility and creativity. The focus should be on creating safer working conditions.
What is a concern regarding aviation strategies in healthcare?
Some providers fear that checklists and protocols may limit their clinical judgment.
What are crucial elements for maintaining safety and efficiency in healthcare?
Effective communication and teamwork.
What does communication in healthcare involve?
Both verbal and non-verbal communication, including clear instructions and situational awareness.
What are the characteristics of teamwork in healthcare?
Dynamic, interdependent, and adaptive interaction toward a shared goal.
Why is training in teamwork and communication essential?
Simulation-based training enhances team coordination and crisis management.
What impact do distractions have in the anesthesia work environment?
Distractions can impact vigilance, situational awareness, and patient safety.
What are examples of external distractions in the anesthesia work environment?
Environmental noise, technology-related disruptions, and unnecessary use of EMR.
What are common causes of distractions in anesthesia?
Reading, phone calls, and loud music.
What is the ‘sterile cockpit’ approach?
Follow this approach during critical phases of patient care to minimize distractions.
What is the most identifiable and preventable cause of medical errors?
Fatigue.
What does anesthesia as a profession require?
Long hours, high vigilance, and management of unpredictable, stressful situations.
What is the impact of work-hour reduction on medical errors?
Allowing 24 hours of sleep between shifts significantly reduces attentional failures and the risk of errors due to drowsiness.
What is the impact of stress on performance?
Stress is a significant factor in both personal and professional performance.
Acute stress leads to fight, flight, or freeze responses. Chronic stress is related to workplace demands and long-term emotional strain.
What are the effects of stress on performance?
Effects of stress include impaired decision-making, increased likelihood of medical errors, and reduced ability to recognize and manage stress in oneself and others.
What are the sources of workplace stress?
Sources of workplace stress include high job demands, uncertain roles & responsibilities, poor support from coworkers or managers, and family and personal stressors.
What are observable effects of stress?
Observable effects of stress include a normally calm colleague becoming irritable and a well-organized provider starting to neglect personal appearance.
How do coping strategies influence stress?
Coping strategies influence whether stress has a positive or negative effect.
What is the significance of patient handoff?
Communication breakdowns contribute to 15%-67% of critical incidents in anesthesia.
What are the most vulnerable points in patient handoffs?
Most vulnerable points include care transitions (e.g., surgery → anesthesia → post-op recovery) and shift changes when new providers assume responsibility.
What is a clinical handover/handoff?
A clinical handover/handoff is the transfer of professional responsibility and accountability for a patient’s care to another provider or team.
How does The Joint Commission define handoff?
The Joint Commission defines handoff as a ‘real-time process’ for ensuring patient safety.
What are the challenges in patient handoffs?
Challenges include inconsistency in information transfer, lack of standardization across different healthcare settings, and widespread dissatisfaction among nurses and physicians regarding handover processes.
What do WHO and The Joint Commission recognize about handover?
The WHO and The Joint Commission recognize handover as a key patient safety initiative.
What industries have received more attention for handoff failures?
Handoff failures in high-risk industries such as aviation and nuclear power have received more attention than in healthcare.
How can patient handoff processes be improved?
Improving patient handoff processes involves standardized communication protocols, structured checklists, encouraging real-time verification and feedback, and using electronic medical records (EMRs) for accurate data transfer.
