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Review article: Biomedical intelligence

Vol. 143 No. 1112 (2013)

Improving patient safety in medicine: is the model of anaesthesia care enough?

  • Guy Haller
DOI
https://doi.org/10.4414/smw.2013.13770
Cite this as:
Swiss Med Wkly. 2013;143:w13770
Published
10.03.2013

Abstract

Avoiding iatrogenic adverse outcomes and providing safe care to patients is a priority in modern healthcare systems. Because anaesthetic practice is inherently risky, the specialty has developed a broad range of strategies to minimise human error and risk for patients. These are part of a hierarchical model developed by industrial safety experts to minimise risk. It is known as the safety hierarchy model. This review will describe the use of this model in anaesthesia and show why the specialty is often cited as a role model for patient safety improvement. It will also explore the extension of the model to other specialties and analyse its intrinsic limitations due to new challenges to patient safety: teamwork and communication issues. These will conclude the review.

References

  1. Donaldson MS, Kohn LT, Corrigan J. To err is human: building a safer health system. Washington, D.C.: National Academy Press; 2000.
  2. Hogan H, Healey F, Neale G, Thomson R, Vincent C, Black N. Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study. BMJ Qual Saf. 2012;21(9):737–45.
  3. Barbour GL. Development of a quality improvement checklist for the Department of Veterans Affairs. Jt Comm J Qual Improv. 1994;20(3):127–39.
  4. McCannon CJ, Hackbarth AD, Griffin FA. Miles to go: an introduction to the 5 Million Lives Campaign. Jt Comm J Qual Patient Saf. 2007;33(8):477–84.
  5. Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ. Temporal trends in rates of patient harm resulting from medical care. N Engl J Med. 2010;363(22):2124–34.
  6. Leape LL, Berwick DM, Bates DW. What practices will most improve safety? Evidence-based medicine meets patient safety. JAMA. 2002;288(4):501–7.
  7. Gaba DM. Anaesthesiology as a model for patient safety in health care. BMJ. 2000;320(7237):785–8.
  8. Barnett rl, Brickmann db. Safety Hierarchy. Journal of Safety Research. 1986;17(2]:49–55.
  9. Layde PM, Cortes LM, Teret SP, Brasel KJ, Kuhn EM, Mercy JA, et al. Patient safety efforts should focus on medical injuries. JAMA. 2002;287(15):1993–7.
  10. McNutt RA, Abrams R, Arons DC. Patient safety efforts should focus on medical errors. JAMA. 2002;287(15):1997–2001.
  11. Cooper JB, Gaba DM, Liang B, Woods D, Blum LN. The National Patient Safety Foundation agenda for research and development in patient safety. MedGenMed. 2000;2(3):E38.
  12. Arbous MS, Grobbee DE, van Kleef JW, de Lange JJ, Spoormans HH, Touw P, et al. Mortality associated with anaesthesia: a qualitative analysis to identify risk factors. Anaesthesia. 2001;56(12):1141–53.
  13. Chopra V, Bovill JG, Spierdijk J. Accidents, near accidents and complications during anaesthesia. A retrospective analysis of a 10-year period in a teaching hospital. Anaesthesia. 1990;45(1):3–6.
  14. Eagle CJ, Davies JM. Current models of “quality” – an introduction for anaesthetists. Can J Anaesth. 1993;40(9):851–62.
  15. Warden JC, Borton CL, Horan BF. Mortality associated with anaesthesia in New South Wales, 1984–1990. Med J Aust. 1994;161(10):585–93.
  16. Lagasse RS. Anesthesia safety: model or myth? A review of the published literature and analysis of current original data. Anesthesiology. 2002;97(6):1609–17.
  17. Cooper JB, Gaba D. No myth: anesthesia is a model for addressing patient safety. Anesthesiology. 2002;97(6):1335–7.
  18. Blake JB. An examination of some recent statistics in regard ether, and a consideration of some present methods of administration. Boston Medical Surgery Journal. 1895;132(559):590.
  19. Beecher HK, Todd DP. A study of the deaths associated with anesthesia and surgery: based on a study of 599, 548 anesthesias in ten institutions 1948–1952, inclusive. Ann Surg. 1954;140(1):2–35.
  20. Memery HN. Anesthesia mortality in private practice. A ten-year study. JAMA. 1965;194(11):1185–8.
  21. Clifton BS, Hotten WI. Deaths Associated with Anaesthesia. Br J Anaesth. 1963;35:250–9.
  22. Lienhart A, Auroy Y, Pequignot F, Benhamou D, Warszawski J, Bovet M, et al. Survey of anesthesia-related mortality in France. Anesthesiology. 2006;105(6):1087–97.
  23. Australian and New Zealand College of Anaesthetists. Safety of Anaesthesia in Australia. In: P.Mackay, editor. A review of Anaesthesia related mortality 1997–1999. Melbourne: Australian and New Zealand College of Anaesthetists; 2002.
  24. Amalberti R, Auroy Y, Berwick D, Barach P. Five system barriers to achieving ultrasafe health care. Ann Intern Med. 2005;142(9):756–64.
  25. Domino KB. Trends in anaesthesia litigation in the 1990s:monitored anesthesia care claims. ASA Newsletter 1997;61(2):15–7.
  26. Lee LA, Domino KB. The Closed Claims Project. Has it influenced anesthetic practice and outcome? Anesthesiol Clin North America. 2002;20(3):485–501.
  27. Lyons G, Macdonald R. Awareness during caesarean section. Anaesthesia. 1991;46(1):62–4.
  28. Cheney FW, Posner KL, Lee LA, Caplan RA, Domino KB. Trends in anesthesia-related death and brain damage: A closed claims analysis. Anesthesiology. 2006;105(6):1081–6.
  29. Staender S, Schaer H, Clergue F, Gerber H, Pasch T, Skarvan K, et al. A Swiss anaesthesiology closed claims analysis: report of events in the years 1987–2008. Eur J Anaesthesiol. 2011;28(2):85–91.
  30. Royal College of Anaesthetists. National Audit Projects (NAP) 2011; Available from: http://www.rcoa.ac.uk/clinical-standards-and-quality/national-audit-projects. Accessed 18 December 2012.
  31. Cooper JB, Cullen DJ, Nemeskal R, Hoaglin DC, Gevirtz CC, Csete M, et al. Effects of information feedback and pulse oximetry on the incidence of anesthesia complications. Anesthesiology. 1987;67(5):686–94.
  32. Tinker JH, Dull DL, Caplan RA, Ward RJ, Cheney FW. Role of monitoring devices in prevention of anesthetic mishaps: a closed claims analysis. Anesthesiology. 1989;71(4):541–6.
  33. Derrington MC, Smith G. A review of studies of anaesthetic risk, morbidity and mortality. Br J Anaesth. 1987;59(7):815–33.
  34. Tiret L, Hatton F, Desmonts JM, Vourc’h G. The implications of a national study of risk of anaesthesia. Health Policy. 1988;9(3):331–6.
  35. Davies JM, Strunin L. Anesthesia in 1984: how safe is it? Can Med Assoc J. 1984;131(5):437–41.
  36. Soreide E, Bjornestad E, Steen PA. An audit of perioperative aspiration pneumonitis in gynaecological and obstetric patients. Acta Anaesthesiol Scand. 1996;40(1):14–9.
  37. Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol. 1946;52:191–205.
  38. Botney R. Improving patient safety in anesthesia: a success story? Int J Radiat Oncol Biol Phys. 2008;71(1 Suppl):S182–6.
  39. Jensen LS, Merry AF, Webster CS, Weller J, Larsson L. Evidence-based strategies for preventing drug administration errors during anaesthesia. Anaesthesia. 2004;59(5):493–504.
  40. Walker IA, Griffiths R, Wilson IH. Replacing Luer connectors: still work in progress. Anaesthesia. 2010;65(11):1059–63.
  41. Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet. 2004 29;363(9423):1757–63.
  42. Merry AF, Webster CS. Labelling and drug administration error. Anaesthesia. 1996;51(10):987–8.
  43. Currie M, Mackay P, Morgan C, Runciman WB, Russell WJ, Sellen A, et al. The Australian Incident Monitoring Study. The “wrong drug” problem in anaesthesia: an analysis of 2000 incident reports. Anaesth Intensive Care. 1993;21(5):596–601.
  44. Howard SK, Gaba DM, Fish KJ, Yang G, Sarnquist FH. Anesthesia crisis resource management training: teaching anesthesiologists to handle critical incidents. Aviat Space Environ Med. 1992;63(9):763–70.
  45. European Society of Anaesthesiology. Helsinki Declaration on Patient Safety in Anaesthesiology 2010; Available from: http://www.euroanaesthesia.org/sitecore/content/Publications/Helsinki%20Declaration.aspx http://www.euroanaesthesia.org/sitecore/content/Publications/Helsinki Declaration.aspx Accessed 20 December 2012.
  46. Auerhammer J. Positioning of the patient for surgery. Anaesthesist. 2008;57(11):1107–24.
  47. Bates DW, Gawande AA. Improving safety with information technology. N Engl J Med. 2003;348(25):2526–34.
  48. Eggimann P, Pittet D. Overview of catheter-related infections with special emphasis on prevention based on educational programs. Clin Microbiol Infect. 2002;8(5):295–309.
  49. Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet. 2000;356(9238):1307–12.
  50. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491–9.
  51. Davies HT, Harrison S. Trends in doctor-manager relationships. BMJ. 2003;326(7390]:646–9.
  52. Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993;342(8883]:1317–22.
  53. Joint Commission on Accreditation of Healthcare Organizations. Root cause analysis in health care: tools and techniques. 2nd ed. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations; 2003.
  54. Gawande AA, Zinner MJ, Studdert DM, Brennan TA. Analysis of errors reported by surgeons at three teaching hospitals. Surgery. 2003;133(6):614–21.
  55. Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med. 2004;79(2):186–94.
  56. Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ. 2000;320(7237):745–9.
  57. Zeltser MV, Nash DB. Approaching the evidence basis for aviation-derived teamwork training in medicine. Am J Med Qual. 2010;25(1):13–23.
  58. Halamek LP, Kaegi DM, Gaba DM, Sowb YA, Smith BC, Smith BE, et al. Time for a new paradigm in pediatric medical education: teaching neonatal resuscitation in a simulated delivery room environment. Pediatrics. 2000;106(4):E45.
  59. Gibbs N, Rodoreda P. Anaesthetic mortality rates in Western Australia 1980–2002. Anaesth Intensive Care. 2005;33(5):616–22.

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