To err is human

Abstract

Anaesthetists work with a wide variety of highly engineered equipment, technology, and drugs to care for our patients. A near-perfect safety record is expected and is (usually) achieved, so the search for improvement in our performance may seem frustrating and perhaps even futile. Drug therapies in anaesthesia have evolved to the point where predictable and safe effectiveness is the norm, as illustrated in the 2009 postgraduate issue of the British Journal of Anaesthesia. Our equipment is also highly evolved, highly effective, and if it fails at all, tends to fail safely. Yet, we still cause harm to our patients. The death of Elaine Bromiley in the UK is a tragic and well-publicized occasion when medicine failed in its care. Perfect care is still some way off, it seems. Can we do more to improve the delivery of anaesthesia? We hope that this postgraduate issue of the British Journal of Anaesthesia will convince the reader that the answer to this question is a resounding ‘yes, we can’. There is significant progress to be made in the way humans perform, interact, respond to crises, and deal with stress. These human factors are explored in the reviews and editorials that follow. In critical care, the outcomes from sepsis, acute respiratory distress syndrome, and head injury have improved only slightly in recent years, despite extensive research in the pathophysiology and treatment. It seems that exploration of human factors may yield useful improvement in the functioning of the critical care unit, and in managing the stress of providing top-quality care in a 24 h, high-intensity environment. The majority of the articles in this issue have been provided by speakers at the Royal College of Anaesthetists’ 2010 Anniversary Meeting, Human Factors in Anaesthesia and Critical Care. This meeting drew together experts from the fields of anaesthesia crisis resource management (ACRM), critical care, training, workplace stress, patient safety, disaster management, aviation, exploration, and space travel. During this vibrant meeting, it became clear that there is enormous enthusiasm for understanding the impact of human factors in anaesthesia and critical care, and a realistic expectation of great improvements being made to our patients’ care through a better understanding of the way we humans function. The emotional and physical stressors affecting doctors working in anaesthesia and critical care have been highlighted previously. 5 In this postgraduate issue, Larsson and Sanner explore the concept of stress in doctors, and offer mental approaches to this important problem. The NHS continues to lose valuable working days due to staff stress and emotional illness, and the impact on the staff involved may be significant and long lasting. It is imperative that we take this issue seriously and manage it openly, rather than bury it behind embarrassment and stigma. ACRM has been growing in importance for two decades and one of its pioneers describes the history and relevance of ACRM in an editorial in this issue. Despite the emergence over the past 20 yr of ACRM as a discipline in its own right, parallels continue to be drawn with human factors in aviation. The implementation of the WHO checklist in UK and international operating room practice 11 mirrors the use of standard operating procedures (SOPs) in aviation. Toff (a pilot and anaesthetist) explores in this issue the similarities between anaesthesia and aviation, and highlights the extraordinary safety level achieved in aviation through the use of protocolization and an understanding of human factors. The opposition of many anaesthetists to heavy reliance on protocols and SOPs is described in the parallel of aviation, and Toff compellingly presents the benefits to be achieved Volume 105, Number 1, July 2010