CRITICAL INCIDENTS AND PERIOPERATIVE EMERGENCIES: ARE FINAL YEAR RESIDENTS AND ANESTHESIOLOGISTS ARE READY?

Abstract

A critical incident (CI) is any failed event that could have been prevented and carries the risk of undesirable consequences for the patient. The study of critical incidents and physicians' preparedness for their occurrence helps to reduce their consequences, risks of recurrence and improve patient safety. The aim of the study was to investigate how well are graduate residents and anesthesiologists prepare to manage critical incidents (CI) and perioperative emergencies (PE) during anesthesia. Methods and Materials: A prospective observational study was conducted at the Bogomolets National Medical University, the postgraduate department of surgery, anesthesiology and intensive care. The study was conducted from May 2022 to June 2023. Anesthesiologists and final year residents were assessed for the acquired competencies in the management of CI and PE: they conducted a self-assessment of their own competencies; passed 1 simulation scenario with an assessment on the CEХ scale during the scenario. Results. The study included 60 final year residents and 24 anesthesiologists. Many of residents (55 %) and anesthesiologists (63 %) generally assessed their readiness to manage CI and PE as high: 45% and 47% respectively considered their level of readiness to be insufficient, including 27% and 8% who assessed it as low. When stratified by the type of CI and PE, it was found that residents and anesthesiologists were best prepared to provide care in case of CI and PE from the side of breathing and airway patency cardiovascular system. Significantly worse anesthesiologists assessed their readiness for rare emergencies, such as malignant hyperthermia, anaphylaxis, local anesthetic systemic toxicity (LAST) (OR 0.35 [0.17- 0.74], p=0.009 for residents and OR 0.25 [0.07-0.8], p=0, 04 for anesthesiologists) and events related to apparatus malfunction, lack of power supply, and catching fire in the respiratory circuit (OR 0.4 [0.2-0.8], p=0.03 for residents and OR 0.25 [0.07-0.8], p=0.04 for anesthesiologists). Anesthesiologists had a significantly higher level of readiness and competence for all individual parameters and the overall mean score during simulation scenarios (7.69±0.53 vs. 5.94±1.6, p<0.0001). Conclusions. Anesthesiologists generally showed higher results in readiness to manage CI and PE during anesthesia. Difficult competencies for both residents and anesthesiologists were the resource management, organizational competencies, and stress resistance.