Patient Safety In Anaesthesiology Research Articles

Preoperative anaesthesia assessment and patient preparation for surgery: update and a review

Although anaesthetic and surgical procedures should be individualised for every patient, in practice many preoperative protocols and routines are used generally. The “Helsinki Declaration on Patient Safety in Anaesthesiology” establishes that the safety and quality of the perioperative care received by patients is the responsibility of anaesthesiologists. This declaration has been accepted by all the European Societies of Anaesthesiology and stipulates that all institutions providing perioperative anaesthesia care to patients should design protocols to guide perioperative patient management. The present article aims to provide an evidenced-based review of preoperative assessment and preparation and to propose a protocol that can be adapted to the needs of each hospital and be incorporated into their routine practice. Emphasis is placed on the importance of correct preoperative evaluation in reducing morbidity and mortality in the surgical patient. This task can be aided by the use of preoperative questionnaires and the rational use of preoperative tests, which will also reduce unnecessary costs. Finally, the most widely accepted recommendations on preoperative fasting is discussed. The anaesthesiologist’s legal responsibility, and patients’ views in the preoperative process are also considered. A thorough clinical preoperative evaluation of the patient is more important than routine preoperative tests, which should be requested only when justified by clinical indications. Moreover, this practice eliminates unnecessary cost without compromising the safety and quality of care.

Patient safety practices in European anaesthesiology: Expert evaluation and ranking.

Patient safety is a key concern of anaesthesiology practice. However, good practices are often not widely shared between departments and hospitals, whether within or between countries. We aimed to collect and analyse safety practices and tips from anaesthesiology departments around Europe in order to facilitate successful transfer of safety knowledge. Review of previously collected safety practices; allocation of numerical scores in order to rank them on 0-5 scales in terms of anticipated impact, and speed, cost, and ease of implementation; free text comment on any possible difficulties or unintended harms which might arise from adopting any of the collected practices. Collaborative remote working of expert group. Nineteen experts in patient safety in anaesthesiology from nine European countries. Rankings of safety practices for anticipated practice impact, cost, speed, and ease of implementation. We collected 117 practices. The highest-ranked items for potential beneficial impact were: standardising the layout of drug trolleys (4.82); involving all staff in new safety initiatives in the operating theatre (4.73); ensuring patients' medical records are available at the time of surgery (4.71); running regular simulation training sessions in departments of anaesthesia (4.67); and creating a difficult airway management trolley (4.65). A major theme to emerge from the qualitative analysis of the experts' free text comments was the risk that practices aimed at enhancing patient safety might not achieve the effect intended, as introducing new safety activities can cause more mistakes during the implementation phase. Many useful practices to promote patient safety were identified, but as some practices appear to be context-dependent, we recommend that a proper, prospective risk assessment is carried out before they are introduced in a new setting. The full list of items is available online as Supplementary Digital Content, http://links.lww.com/EJA/A785 . Not applicable.

Knowledge and Attitudes about Helsinki Declaration on Patient Safety among Anaesthesiologists in Turkey: A Questionnaire Study.

ObjectiveThe Helsinki Declaration on Patient Safety in Anaesthesiology is an important document for anaesthesiologists. This study aimed to evaluate the knowledge and experiences of anaesthesiologists in Turkey on the “Helsinki Declaration on Patient Safety.”MethodsAfter the ethics committee approval and participants’ consent, electronic questionnaires were sent to anesthetists working in Turkey. The questionnaire included 48 questions.ResultsThe mean age of the participants was 44.28±8.01 years, and 52.1% were women (n=142). The mean time spent in the field of anesthesiology was 12.83±7.76 years. The percentage of participants working in private hospitals was 13.4%. A total of 58.5% of the participants were educated on patient safety out of whom 57% said that their knowledge was sufficient, 37.3% said that it was limited, and 5.6% felt that it was insufficient. The knowledge of participants about the Helsinki Declaration was sufficient in 31.7%, limited in 39.4%, insufficient in 9.2%, and 19.7% had no knowledge. A total of 27% of participants believed that implementation of the Helsinki Declaration improved patient safety. It has been stated that the minimum patient monitoring standards recommended by the European Board of Anaesthesiology has been complied in operating rooms and recovery units (90.8% and 78.2%, respectively).ConclusionThe findings of this survey might guide not only the individual anesthetists but also hospital administrators to develop strategies to improve patient safety and thus quality of care in the light of the recommendations listed in the Helsinki Declaration.

Ten years of the Helsinki Declaration on patient safety in anaesthesiology: An expert opinion on peri-operative safety aspects.

: Patient safety is an activity to mitigate preventable patient harm that may occur during the delivery of medical care. The European Board of Anaesthesiology (EBA)/European Union of Medical Specialists had previously published safety recommendations on minimal monitoring and postanaesthesia care, but with the growing public and professional interest it was decided to produce a much more encompassing document. The EBA and the European Society of Anaesthesiology (ESA) published a consensus on what needs to be done/achieved for improvement of peri-operative patient safety. During the Euroanaesthesia meeting in Helsinki/Finland in 2010, this vision was presented to anaesthesiologists, patients, industry and others involved in health care as the 'Helsinki Declaration on Patient Safety in Anaesthesiology'. In May/June 2020, ESA and EBA are celebrating the 10th anniversary of the Helsinki Declaration on Patient Safety in Anaesthesiology; a good opportunity to look back and forward evaluating what was achieved in the recent 10 years, and what needs to be done in the upcoming years. The Patient Safety and Quality Committee (PSQC) of ESA invited experts in their fields to contribute, and these experts addressed their topic in different ways; there are classical, narrative reviews, more systematic reviews, political statements, personal opinions and also original data presentation. With this publication we hope to further stimulate implementation of the Helsinki Declaration on Patient Safety in Anaesthesiology, as well as initiating relevant research in the future.

Patient safety and the role of the Helsinki Declaration on Patient Safety in Anaesthesiology

The Helsinki Declaration on Patient Safety was launched in 2010 by the European Society of Anaesthesiology and the European Board of Anaesthesiology. It is not clear how widely its vision and standards have been adopted. To explore the role of the Helsinki Declaration in promoting and maintaining patient safety in European anaesthesiology. Online survey. A total of 38 countries within Europe. Members of the European Society of Anaesthesiology who responded to an invitation to take part by electronic mail. Responses from a 16-item online survey to explore each member anaesthesiologist's understanding of the Declaration and compliance with its standards. We received 1589 responses (33.4% response rate), with members from all countries responding. The median [IQR] response rate of members was 20.5% [11.7 to 37.0] per country. There were many commonalities across Europe. There were very high levels of use of monitoring (pulse oximetry: 99.6%, blood pressure: 99.4%; ECG: 98.1% and capnography: 96.0%). Protocols and guidelines were also widely used, with those for pre-operative assessment, and difficult and failed intubation being particularly popular (mentioned by 93.4% and 88.9% of respondents, respectively). There was evidence of widespread use of the WHO Safe Surgery checklist, with only 93 respondents (6.0%) suggesting that they never used it. Annual reports of measures taken to improve patient safety, and of morbidity and mortality, were produced in the hospitals of 588 (37.3%) and 876 (55.7%) respondents, respectively. Around three-quarters of respondents, 1216, (78.7%) stated that their hospital used a critical incident reporting system. Respondents suggested that measures to promote implementation of the Declaration, such as a formal set of checklist items for day-to-day practice, publicity, translation and simulation training, would currently be more important than possible changes to its content. Many patient safety practices encouraged by the Declaration are well embedded in many European countries. The data have highlighted areas where there is still room for improvement.

Intensive therapy systemic toxicity of local anesthetics (clinical guidelines)

Development of the systemic toxicity of local anesthetics can quickly lead to severe bradycardia and hypotension, up to cardiac arrest. The presented clinical recommendations designed to optimize medical care and are included in the list of mandatory clinical protocols according to the Helsinki Declaration on Patient Safety in Anaesthesiology. This review summarizes the main mechanisms of toxicity when using local anesthetics. The guidelines set out criteria and signs of systemic toxicity, recommendations for its prevention. The algorithm of action and recommended dosage of drugs. An intensive care protocol systemic toxicity of local anesthetics including the use of lipid emulsion.

Safety-II and resilience: the way ahead in patient safety in anaesthesiology.

Anaesthesiology is a specialty with a remarkable track record regarding improvements in safety. Nevertheless, modern healthcare poses increasing demands on quality and outcome: more complexity, more patients with increasing risk-factors, more regulation from society concerning quality and outcome and finally more demand of the stakeholders for efficiency. This leads us to ask the question if our traditional way of handling 'risk' and 'safety' will stand the challenges of the future? Most of the success of modern anaesthesiology results from improved technology, pharmacology, training and education, improved systems, focus on human performance as well as standardization and development of guiding information. All of these aspects are crucial and have their relevance for well tolerated and modern practice. But despite all of these achievements, we must face the fact that we still cannot control complex processes by application of linear thinking (standardization). Modern risk-management concepts in other ultra-safe systems such as civil aviation or air traffic control introduced the concept of 'resilience' as well as 'safety-II' in order to deal with the challenges of increasing complex conditions. We are well advised to consider adapting these modern concepts of 'resilience' and 'safety-II' thinking when we want to substantially improve patient safety in anaesthesiology.

Editorial introductions

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Thomas Fuchs-BuderThomas Fuchs-BuderThomas Fuchs-Buder, MD, is full Professor of Anesthesia and Critical Care at the Medical Faculty of the University of Lorraine in Nancy, France. He earned his medical degree at the Justus-Liebig-University in Gieβen, Germany. He completed his residency training at the University of Geneva in Geneva, Switzerland. He was staff at the Geneva University Hospital before moving the University of Saarland in Homburg/Saar, Germany and finally joined the department of Anaesthesia and Critical Care at the CHU de Nancy/Brabois, France in 2002. His area of research interest is pharmacology and physiology of the neuromuscular transmission. Prof. Fuchs-Buder serves on the editorial board of the European Journal of Anaesthesiology, he is chair of the Ambulatory Anaesthesia Subcommittee at the European Society of Anaesthesiology. Sven StaenderSven StaenderPD Dr Staender is Head of the Department of Anaesthesia and Intensive Care Medicine at Spital Maennedorf, Zuerich, Switzerland. He earned his medical degree at the University of Erlangen, Germany. He completed his residency training at University of Basel, Switzerland. His areas of interest are in patient safety and risk management in anesthesiology. PD Dr Staender was involved in the early development of an electronic incident reporting system (CIRS) in anesthesiology at the University of Basel back in 1995. He served as the chairman of the scientific subcommittee on patient safety of the European Society of Anaesthesiology (ESA) where he was involved in the development of the Helsinki Declaration on Patient Safety in Anaesthesiology. He is the current Chairman of the Patient Safety Taskforce of the ESA and an advisory board member of the European Patient Safety Foundation (EuPSF). He, furthermore, serves as a reviewer of the European Journal of Anaesthesiology, Acta Anaesthesiologica Scandinavica and the journal Critical Care Medicine.

Can anaesthetic management improve the outcome?

Despite anaesthesia-specific pharmacological and technological innovations in the last decades we are definitely aware that anaesthesia per se has the potential to induce changes in the balance of human physiology that in turn may have relevant consequences, i.e. an increase in postoperative morbidity and mortality. Today anaesthesia appears to be extremely safe, with the number of deaths solely attributed to anaesthesia having reached its lowest point in history (0.055 per 10 000 anaesthetics). However, the available data regarding anaesthesia-related mortality, solely or contributory, are not consistent and the interpretation and legibility is limited. Fortunately, the issue of "patient safety in anaesthesiology" has gained increasing interest in the last few years, yielding some very promising projects. Since most of the ideas are focused on intraoperative safety improvement strategies, it seems to be reasonable in the near future to expand to the complete perioperative period, especially the postoperative care on the ward in high-risk patients. This knowledge, combined with an ongoing promotion of patient safety in anaesthesiology and provision of adequate resources definitely will increase patient safety. Hopefully, in the end, our efforts will contribute to integrate the "patient safety in anaesthesiology concept" in daily clinical routine.

EVALUATION OF MULTIDISCIPLINARY SIMULATION-BASED TEAM TRAINING: THE WAY FORWARD FOR TRAINING ICU TEAMS

In May 2010, The Helsinki Declaration for Patient Safety in Anaesthesiology was launched by the two major anaesthetic societies in Europe. The ICU environment is especially unforgiving for mistakes due to the multidisciplinary, time-critical nature of care and vulnerability of the patients. Human factors account for the majority of adverse events and a sound safety climate is therefore essential [1]. Endangerment of patients by deficits in the field of Human Factors (HF) is especially tragic, as it should be avoidable in most cases. Simulation trainigs provide a valuable tool to train the management of complex medical situations thus reducing the occurrence of fatal errors and increasing patient safety. We demonstrate the effects of trainigs by the means of a “ Pre- and Post-Training Self-Evaluation Questionnaire“ [2]. In addition, the debriefing after each training was evaluated by a standardised questionnaire (Debriefing Assessment for Simulation in Healthcare, DASH©).

The Helsinki Declaration on Patient Safety in Anaesthesiology: the past, present and future.

Four years after the launch of the Helsinki Declaration on Patient Safety in Anaesthesiology, it is of interest to assess its role in European and Global Patient Safety efforts. The Declaration is widely supported, not only in Europe, but also has attracted much attention and support globally. In Europe, it represented a major step in European-wide patient safety networking and initiatives. The European Patient Safety Task Force, created jointly by the European Board of Anaesthesiology and the European Society of Anaesthesiology, has developed useful monitoring and introduction tools. A new Patient Safety Committee is being introduced, and this will facilitate current and future initiatives. The launch of Helsinki Declaration of Patient Safety in Anaesthesiology in 2010 was a major step forward for patient safety initiatives in European and Global anesthesiology. Several steps have been taken in the 4 years that have passed, but the task needs continuous attention to ensure that every patient received the safest possible anesthesiology care.

Procedural sedation and analgesia for gastrointestinal endoscopy in infants and children: how, with what, and by whom?

Endoscopic procedures involving the gastrointestinal tract have been successfully developed in paediatric practice over the last two decades, improving both diagnosis and treatment in many children's gastrointestinal diseases. In this group of patients, experience and co-operation between paediatricians/endoscopists and paediatric anaesthesiologists should help to guarantee the quality and safety of a procedure and should additionally help to minimise the risk of adverse events which are greater the smaller the child is. This principle is more and more important especially since the announcement of the Helsinki Declaration on Patient Safety in Anaesthesiology in 2010, emphasising the role of anaesthesiology in promoting safe perioperative care. The Helsinki Declaration has been endorsed by all European anaesthesiology institutions as well as the World Health Organisation's 'Safe Surgery Saves Lives' initiative including the 'Surgical Safety Checklist'. Although most of these procedures could be performed by paediatricians under procedural sedation and analgesia, children with congenital defects and serious coexisting diseases (ASA ≥ III) as well as the usage of anaesthetics (e.g. propofol) must be managed by paediatric anaesthesiologists. We have reviewed the specific principles employed during qualification and performance of procedural sedation and analgesia for gastrointestinal endoscopy in paediatrics. We have also tried to answer the questions as to how, with what, and by whom, procedural sedation for gastrointestinal endoscopy in children should be performed.

Three years after the launch of the Helsinki Declaration on patient safety in anaesthesiology

Three years after the launch of the Helsinki Declaration on patient safety in anaesthesiology

Deklaration von Helsinki zur Patientensicherheit in der Anästhesiologie - Teil 8: SOP zur Überprüfung von Geräten und Medikamenten

In 2010 the Helsinki Declaration on Patient Safety in Anaesthesiology was launched. In this joined statement under the auspice of the European Society of Anaesthesiology the need for protocols for different aspects of perioperative procedures that could affect patient safety was stated. All participating institutions should have--among others--protocols for checking equipment and drugs required for the delivery of safe anaesthesia. The background for this being the fact that the lack of carefully checking equipment and drugs--or not adhering to existing checklists--is a latent threat to patient safety and thus may increase morbidity and mortality.In this part of a series the authors present protocols existing in their clinic for checking anaesthesia equipment and drugs.

Deklaration von Helsinki zur Patientensicherheit in der Anästhesiologie - Teil 6: Präoperative Evaluation und Vorbereitung

The Helsinki Declaration offers guidelines for the warranty and improvement of patient safety in Anaesthesiology. The assessment of elective patients and their preoperative optimization plays a key role herein. Individual risk factors and preexisting pathologies have to be identified in order to initiate specific pre- and aftercare and an appropriate monitoring. The measures need to be evidence-based, goal-oriented and efficient. Our recommendations aim at elective adult patients planned for non-cardiac and non-lung-resecting surgery and stress the importance of gathering information from patients, performing physical examinations and arranging further diagnostic customized upon these findings only in contrast to routine testing. They shall spark the formulation or improvement of center-based, interdisciplinary standards of procedure in order to fulfill our great responsibility for the perioperative care of our patients.

All we ever wanted to know about perioperative bleeding

All we ever wanted to know about perioperative bleeding

Directrices de procedimientos de comprobación y validación («chequeo») previos a la anestesia de la Sociedad Española de Anestesiología

We present this document as a guide to preparing a specific institutional pre-anaesthesia checklist, as recommended in the Helsinki declaration on patient safety in anaesthesiology. Also, the recently recommended WHO “safe surgery check-list” includes a check-list for anaesthesia. A working group was established in accordance with the charter of the Spanish Society of Anaesthesiology and Resuscitation (Sociedad Española de Anestesiología y Reanimación [SEDAR]). The new patient safety culture introduced into medicine, and the recommendations of European anaesthesia societies has led us to design and update protocols in order to improve results in this important part of our speciality.We have prepared these recommendations or guidelines using, as examples, updates of pre-anaesthesia check-lists by other American (ASA), British, or Canadian societies of anaesthesia. With that aim, we enlisted the help of anaesthesia ventilator experts and the participation and advice of experienced anaesthesiologists from all parts of Spain. After various corrections and modifications, the document was available at www.sedar.es, so that any anaesthesiologist could propose any correction, or give their opinion. Finally, these guidelines have been approved by the SEDAR Board of Directors, before it was sent for publication in this journal.The aims of this document are to provide: a guideline applicable to all anaesthesia machines, a descriptive pre-anaesthesia check-list that include everything necessary for the anaesthesia procedure, and a resumed check-list to be available in all the anaesthesia machines or other equivalent, but prepared for each institution, which should include anaesthetic equipment and drugs. So, in order to ensure the aims and requirements of the European Board of Anaesthesiology, the European Society of Anaesthesiology, and the WHO are met, each institution should have a protocol for checking equipment and drugs. These guidelines are applicable to any anaesthesia equipment, enabling every institution to develop their own checking protocols, adapted to their anaesthesia machines and their procedures. With the consent of the SEDAR, this group will collaborate with anaesthesia machines providers in order to develop specific checklists for each of their models that will be available at www.sedar.es

Patient safety in anaesthesia

Patient safety in anaesthesia

Continent-wide anaesthesia guideline

De Hert S, Imberger G, Carlisle J, et al. Preoperative latest evidence-based medical knowledge to simplify and/or eliminate unnecessary steps. Physicians are expected to be familiar with clinical guidelines, but should note that they are advisory in nature and are there to help with safer decision making, something which might vary according to the patient’s condition and the available resources. Practice guidelines should be revised periodically to accommodate newly published data. In 2007, the Anaesthesiology Board of European Union of Medical Specialists published guidelines for the safety and quality of anaesthesia. A more recent milestone was the Helsinki Declaration on Patient Safety in Anaesthesiology published in June 2010. This represented a European consensus on measures to improve patient care and it set out a framework for good practice. In order to constrain costs and standardise practice across Europe, the European Society of Anaesthesiologists (ESA) took a giant step forward by committing to the development of evidenced-based clinical guidelines and recommendations. In this issue, the unique specific task force, led by Professor Stefan De Hert, has published an outstanding guideline for the preoperative evaluation of adult patients undergoing elective non-cardiac surgery. Their recommendations are very comprehensive. They cover a wide range of topics that include cardiovascular disease, respiratory disease, obstructive sleep apnoea (OSA), renal disease, diabetes, obesity, coagulation disorders, anaemia, the elderly patient, alcohol addiction and allergy. They also cover concurrent medication, and preoperative testing. In addition, there is a very useful section on airway evaluation.

The Helsinki Declaration on Patient Safety in Anaesthesiology

Anaesthesiology, which includes anaesthesia, perioperative care, intensive care medicine, pain therapy and emergency medicine, has always participated in systematic attempts to improve patient safety. Anaesthesiologists have a unique, cross-specialty opportunity to influence the safety and quality of patient care. Past achievements have allowed our specialty a perception that it has become safe, but there should be no room for complacency when there is more to be done. Increasingly older and sicker patients, more complex surgical interventions, more pressure on throughput, new drugs and devices and simple chance all pose hazards in the work of anaesthesiologists. In response to this increasingly difficult and complex working environment, the European Board of Anaesthesiology (EBA), in cooperation with the European Society of Anaesthesiology (ESA), has produced a blueprint for patient safety in anaesthesiology. This document, to be known as the Helsinki Declaration on Patient Safety in Anaesthesiology, was endorsed by these two bodies together with the World Health Organization (WHO), the World Federation of Societies of Anaesthesiologists (WFSA), and the European Patients' Federation (EPF) at the Euroanaesthesia meeting in Helsinki in June 2010. The Declaration represents a shared European view of that which is worthy, achievable, and needed to improve patient safety in anaesthesiology in 2010. The Declaration recommends practical steps that all anaesthesiologists who are not already using them can successfully include in their own clinical practice. In parallel, EBA and ESA have launched a joint patient safety task-force in order to put these recommendations into practice. It is planned to review this Declaration document regularly.