Risk Management In Anesthesia Research Articles

Bow-tie diagrams for risk management in anaesthesia.

Bow-tie analysis is a risk analysis and management tool that has been readily adopted into routine practice in many high reliability industries such as engineering, aviation and emergency services. However, it has received little exposure so far in healthcare. Nevertheless, its simplicity, versatility, and pictorial display may have benefits for the analysis of a range of healthcare risks, including complex and multiple risks and their interactions. Bow-tie diagrams are a combination of a fault tree and an event tree, which when combined take the shape of a bow tie. Central to bow-tie methodology is the concept of an undesired or 'Top Event', which occurs if a hazard progresses past all prevention controls. Top Events may also occasionally occur idiosyncratically. Irrespective of the cause of a Top Event, mitigation and recovery controls may influence the outcome. Hence the relationship of hazard to outcome can be viewed in one diagram along with possible causal sequences or accident trajectories. Potential uses for bow-tie diagrams in anaesthesia risk management include improved understanding of anaesthesia hazards and risks, pre-emptive identification of absent or inadequate hazard controls, investigation of clinical incidents, teaching anaesthesia risk management, and demonstrating risk management strategies to third parties when required.

Risk management in anesthesia and critical care medicine

Throughout its history, anesthesia and critical care medicine has experienced vast improvements to increase patient safety. Consequently, anesthesia has never been performed on such a high level as it is being performed today. As a result, we do not always fully perceive the risks involved in our daily activity. A survey performed in Swiss hospitals identified a total of 169 hot spots which endanger patient safety. It turned out that there is a complex variety of possible errors that can only be tackled through consistent implementation of a safety culture. The key elements to reduce complications are continuing staff education, algorithms and standard operating procedures (SOP), working according to the principles of crisis resource management (CRM) and last but not least the continuous work-up of mistakes identified by critical incident reporting systems.

Risk management and anesthesia

Risk management in Anesthesia is a crucial part of patient safety. Because anesthesia care is usually considered as facilitative rather than therapeutic, the outcome of anesthesia care has traditionally been measured in terms of the absence of 'complications'. Consequently, anesthetists have been at the forefront of clinical risk management. It can be described in five stages as follows: risk awareness, risk identification, risk assessment, risk management, and re-evaluation. By identifying the strong points and the weakest points in concurrent health systems; policies and procedures can be implanted in order to ensure effective risk control. If applied correctly and not limited to compelling statistics, risk management can be a powerful, highly beneficial aid to our practice.

Clinical risk management in anaesthesia

Clinical risk management in anaesthesia

Clinical risk management in anaesthesia

Clinical risk management in anaesthesia

Klinisches Risikomanagement

The main goal of a medical risk management system is reduction of treatment errors and the primary focus is patient safety. A task force on risk management in anaesthesia was established in the department of Anaesthesiology and Intensive Care at the University Hospital Dresden with the aim to implement a critical incident reporting system (CIRS) followed by a structured analysis. The theoretical basic principles and tools for the incident analysis are presented. The task force developed a machine-readable, structured, anonymous questionnaire, which was implemented in clinical practice after a primary test period. Prerequisites for the implementation of an effective CIRS are support from the department head, anonymity, independence of the task force from the department head and competence of the task force to initiate changes and improvements. CIRS is a powerful tool to register and analyse critical incidents and may influence the following domains: education and training (human factors), medical equipment (technical factors), quality of working processes and departmental communication (organisational factors).

7 Risk assessment and risk management in anaesthesia

The understanding of the basis of anaesthetic risk has changed from the concept of human error, to human factors interactions, to a system-oriented model. This model incorporates the importance of actions of individuals and organizational flaws. Risk control comprises risk prevention (assessment), avoidance (elimination) and reduction. The last of these requires a method for recognizing, managing and investigating untoward events. One such method is presented. Risk financing is the ability of organizations to pay for losses related to poor outcome. For anaesthetists, this represents fees for medical indemnity. Finally, the purpose of risk management, combined with quality assurance activities to ensure optimal patient care, is explained.

Clinical risk management in anaesthesia.

Clinical risk management in anaesthesia.

Risk Management in Anesthesia

Risk Management in Anesthesia

Risk and Outcome of Anesthesia

The current anesthesia patient safety movement is about a decade old, having started with the establishment of a Patient Safety and Risk Management Committee of the American Society of Anesthesiologists (ASA). By the middle of the 1980s, the Anesthesia Patient Safety Foundation was incorporated, and the first Anesthesia Standards were published by Harvard¹and subsequently by the ASA. During the same period a number of books and review journals on risk management in anesthesia have been published, beginning with a 1984<i>International Anesthesiology Clinics</i>volume entitled "Analysis of Anesthetic Mishaps."²These publications have come largely from the English-speaking and other Western countries. Most writers have examined anesthesia risk from a historical perspective and then taken various approaches to review the complete subject. In 1988 David L. Brown, MD, edited the first edition of a book entitled<i>Risk and Outcome in Anesthesia</i>,³taking a unique approach. After examining

Risk management in anaesthesia

Anaesthesia may be considered as an unnatural state which carries inherent risks. Unconsciousness itself may result in airway obstruction, pulmonary aspiration and trauma caused by continuous pressure on tissues. Most anaesthetic drugs have undesirable side effects on the cardiovascular and/or respiratory system, and many are lethal if given in excess dosage. The use of muscle relaxants paralyses all muscles, including those used in ventilation; the paralysed patient is dependent totally on the anaesthetist and his equipment for maintenance of ventilation, and any human or mechanical failure in this regard may result rapidly in cerebral damage or death. In some circumstances, deliberate trespass is made on the respiratory or cardiovascular system in order to enable surgery to be performed under optimal conditions; for example, one lung may be collapsed deliberately during thoracic surgery, and hypotension may be induced to allow complex surgery to take place with minimal haemorrhage. The health of the patient is also an important factor in the genesis of complaints about anaesthetic management. The majority of patients who undergo elective surgery are healthy. While they are prepared to accept that surgery itself may not be entirely successful, or may be associated with a small incidence of complications, they anticipate perfection from the anaesthetist. Anaesthesia is now extremely safe; mortality associated with anaesthesia alone occurs in less than 1 in 100,000 cases [1]. However, because of its apparent safety, surgeons now offer increasingly heroic procedures to patients with serious concurrent disease. In such patients, the risks of anaesthesia are increased significantly, but again patients or their relatives are often unwilling to acknowledge that any risk from anaesthesia is acceptable.