Short Communications: : Causes and Consequences of Complaints Against Anesthesiologists: A 5-year Retrospective Study (original) (raw)
Related papers
A critical incident reporting systme in anaesthesia
Central African Journal of Medicine, 2001
Objective: To audit the recently established Critical Incident Reporting System in the Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe Medical School. The system was set up with1 the purpose of improving the quality of care delivered by the department. Design: Cross sectional study. A critical incident was defined as 'any adverse and reversible event in theatre, during or immediately after surgery that if it persisted without correction would cause harm to the patient'. The anaesthetic or recovery room staff filled a critical incident form anonymously. Data was collected from critical incident reporting forms for analysis. Setting: The anaesthetic service in the two teaching hospitals of Harare Central and Parirenyatwa General Hospitals. Subjects: Between May and October 2000, 62 completed critical incident forms were collected. Main Outcome Measures: The nature of the incident and the monitoring used were recorded, the cause was classified as human, equipment or monitoring failure and the outcome for each patient reported. There was no formal system for reminding staff to fill in their critical incident forms. Results: Atotal of 14165 operations were performed over the reporting period: 62 critical incident forms were collected, reporting 130 incidents, giving a rate of 0.92% (130/14165). Of these, 42 patients were emergencies and 20 elective. The incidents were hypotension, hypoxia, bradycardia, ECG changes, aspiration, laryngospasm, high spinal, and cardiac arrest. Monitoring present on patients who had critical incidents was: capnography 57 %, oxymetry 90 % and ECG 100 %. Other monitors are not reported. Human error contributed in 32/62. of patients and equipment failure in 31/62 of patients. Patient outcome showed 15 % died, 23 % were unplanned admissions to HDU while 62 % were discharged to the ward with little or no adverse outcome. Conclusion: Despite some under reporting, the critical incident rate was within the range reported in the literature. Supervision o f juniors is not adequate, especially on call. The stress under which everyone has to work includes poor morale, drug shortages, poor equipment and power cuts with no backup generator. Despite this, the challenge for senior personnel is to improve quality of care. In other countries similar audits have led to change o f practice and improvement in the safety features of the service provided by the hospital and staff.
Drug, Healthcare and Patient Safety
Background: Post-anesthesia recovery is a continuous process which is considered to be complete after the patient returns to their preoperative physiological state. Although all patients who have had an operation under anesthesia are in a potentially unstable physiological state, most patients recover safely without significant problems due to better and immediate post-anesthesia care. Therefore, this study aimed to assess the staffing and service provision in the post-anesthesia care unit. Methods: A multicenter, institution-based cross-sectional study was conducted in postanesthesia care units from November 28 to December 31, 2020. The data were collected using a questionnaire prepared from standards and guidelines of the American Society of Anesthesiologists, the American Association of Nurse Anesthetists, and the Royal College of Anesthetists by direct observation. Results: Ten hospitals found in Amhara regional state were examined for their staffing of and service provision in their post-anesthesia care units. The total ratio of nurses assigned in post-anesthesia care units to post-anesthesia care unit beds was around 1:3, with a minimum and a maximum ratio of 1:8 and 1:2, respectively. The average number of patients admitted in post-anesthesia care units per week was 98. Eighty percent of the hospitals' post-anesthesia care units had no policy or caregivers for cardiac arrest management. Conclusions and Recommendations: Standards, policies, and guidelines are not well prepared and posted so as to be visible to every caregiver. The majority of the hospitals have staff without special training for the management of possible complications in the postanesthesia care unit. Generally, hospitals need to ensure standardized patient care in the postanesthesia care unit for better and safer patient outcomes.
Quality and patient safety in anesthesia service: Thai survey
Asian Biomedicine, 2010
Background: The Royal College of Anesthesiologists of Thailand (RCAT) performed large-scale epidemiologic study of anesthesia-related complications and national incidents study in 2004 and 2007, respectively. Objectives: Evaluate the anesthesia service in Thailand with regard to status of quality and patient safety. Material and methods: A pre-planned structured questionnaire regarding demographic, administrative, preanesthetic, intraoperative postanesthetic variables and complications were requested to be filled in by nurse anesthetists attending the refresher course lecture of RCAT in February 2008. Descriptive statistics was used. Results: Three hundred fifty questionnaires were given and 341 respondents (97%) returned the questionnaires. Most of the respondents (90%) worked in government section. Thirty percent of respondents practiced in hospital without medical doctor anesthesiologist and 58% of nurse anesthetists worked in hospitals that have been accredited. Forty-six percent of respondents reported unavailability of a 24-hour recovery room. The questionnaires revealed of inadequacy of anesthesia personnel (64%), inadequate supervision during emergency condition (53%), inadequacy of patient information regarding anesthesia (57-69%), and low opportunity for patient to choose choice of anesthesia (19%). The commonly used monitoring were pulse oximeter (92% of respondents) and electrocardiography (63%). One-third (32%) of respondents had to provide of anesthesia for patients with insufficient NPO (non per oral) time. Common problems that the respondents experienced were miscommunication (49%), intraoperative cardiac arrest during the past year (35%), error related to infusion pump (24%) and medication error (8%). Fifty-five percent of respondents had to monitor at least one patient per month receiving spinal anesthesia. Conclusion: Suggested strategies for quality and patient safety improvement in anesthesia service are increasing personnel, increasing 24-hour recovery room, improvement of supervision, improvement of communication, compliance to guidelines and improvement of nurse anesthetist's training regarding monitoring patient receiving spinal anesthesia and cardiopulmonary resuscitation.
International Journal of Advanced Research (IJAR), 2019
Background: Health care quality is meant for survival and to bring excellence in hospitals. It is the demand of all stakeholders (i.e., patients, health care providers, governments, regulators, and competitors). Excellent services can be used as a competitive strategic tool. Anaesthesia is a speciality in medicine which deals with the safety of the patient who is undergoing a surgical procedure. Aim and objectives: To estimate quality of patient management in aspects like prophylactic antibiotic adherence, modification of anaesthesia and surgery plan, management of adverse events and control of mortality rates. Methods: It is a prospective observational study conducted in a sample size of overall 3868 patients in which 1252 patient?s undergone surgery following anaesthesia during the period of January ? November in 2016. Results: In this study, we measured the highest percent of patients non adherence to prophylactic antibiotics is seen in month of November (8.1%) followed by October (3.1%)., A highest percent of unplanned ventilation is seen in month of October (1.55%). the organization?s procedure to prevent adverse events like wrong site, wrong patient and wrong surgery have been (100%)from January to august, a highest percent of 1.31% of patients in April had changed the planned surgery intra operatively. There were no adverse events & mortality rates observed in our study. Conclusion: To increase the quality of patient management care must be taken in improving the patients prophylactic antibiotic adherence, continuous monitoring of vitals and maintaining check lists by physicians or medical staff ,to prevent the situations like unplanned ventilation during surgery, Multidisciplinary simulation training in anaesthetic emergencies may be beneficial for better patient safety.
Audit on Postanaesthetic Patient Handover at the Recovery Room, Completing the Audit Cycle
Journal of Anesthesia & Critical Care: Open Access
Background: Postoperative patient handover by anaesthetists to recovery room staff is a core part of postoperative care. This includes the transfer of information about the patients' preoperative condition, the nature of surgery and anaesthesia (including any intraoperative problems) and postoperative management plan. To improve patient handover in the recovery room, we choose to adopt ''patient handover standards'' from the Australian Medical Association and British Doctors Committee. These standards were introduced at an audit meeting. Following this introduction, we performed an audit which demonstrated poor compliance. A training program was instituted and re-audit demonstrated an improvement in adherence with the standards. Methods: We performed an audit on postanaesthetic patient handover using the standards set out in '' patient handover standards'' from the Australian Medical Association, 2006 and British Doctors Committee, 2004. This was carried out in the recovery room in Gondar University hospital between March 18-May 27, 2013. A trained observer recorded the handover process against all the eleven elements of the standard. Information was collected from a total of 124 handovers taking place between 30 anaesthetists and 12 nurses in the recovery room. This included a wide range of surgical specialities, and both general and regional anaesthesia. Results: The first audit result revealed that postoperative patient handover practice of anaesthetists was poor in the areas (percentages show level of correct performance based on the standards) of patient identity 3.2%, preoperative patient condition 0%, type of operation 82.2%, type of anaesthesia 82.2%, intraoperative vital signs 87.1%, intraoperative analgesia use 62.9%, intraoperative fluid management 59.7%, intraoperative blood loss 8.1%, intraoperative clinical incidents 3.2%, recovery condition 45.1% and postoperative management plan 3.2%. These areas of practice were improved after training. Conclusion and recommendation: The postoperative patient handover practice of graduate anaesthetists (finished undergraduate course) was remarkably improved after training. We suggest that regular training on postoperative patient handover needs to be provided for both graduate and qualified anaesthetists. Moreover, regular re-auditing is required until the anaesthetists meet the standards and to ensure patient safety in the course of postoperative patient care.