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Alanzi A, Ghazzal S, Abduljawad S, Ghuloom A, Fouad A, Adeel S. Importance of Pre-anesthetic Evaluation in Diagnosing Coexisting Asymptomatic Medical Conditions: A Report of Two Cases. Cureus 2023; 15:e46250. [PMID: 37908946 PMCID: PMC10614173 DOI: 10.7759/cureus.46250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
The preoperative assessment of patients undergoing surgery, often conducted in pre-anesthesia clinics, plays an important role in ensuring patient safety and optimizing perioperative outcomes. This assessment aids in identifying underlying medical conditions that might otherwise remain asymptomatic until they manifest as complications during or after surgery. Through these two case reports, the importance of pre-anesthesia assessment is highlighted. The first case involves a 67-year-old male whose surgery for lymph node excision was planned. However, during the preoperative assessment, atrial fibrillation and pulmonary hypertension were identified, necessitating further intervention and treatment adjustments before surgery. In the second case, an eight-year-old child with a history of vomiting and abdominal pain planned for tonsillectomy was discovered to have congenital hypothyroidism through a vigilant preoperative evaluation. Timely intervention and consultation with an endocrinologist ensured a safe surgery without complications. These cases emphasize the role of preoperative cardiovascular assessment, the utility of electrocardiograms (ECGs), and the relevance of routine laboratory tests in reducing perioperative mortality. Hence, pre-anesthesia assessments are not mere routine steps; they are essential components of patient care that significantly impact perioperative results.
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Affiliation(s)
- Ahmed Alanzi
- Anesthesia and Critical Care, King Hamad University Hospital, Muharraq, BHR
| | - Samar Ghazzal
- Anesthesia and Critical Care, King Hamad University Hospital, Muharraq, BHR
| | | | - Ameera Ghuloom
- General Practice, Ministry of Health - Bahrain, Manama, BHR
| | - Amir Fouad
- Anesthesia and Critical Care, King Hamad University Hospital, Muharraq, BHR
| | - Shahid Adeel
- Anesthesia and Critical Care, King Hamad University Hospital, Muharraq, BHR
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Kristoffersen EW, Opsal A, Tveit TO, Berg RC, Fossum M. Effectiveness of pre-anaesthetic assessment clinic: a systematic review of randomised and non-randomised prospective controlled studies. BMJ Open 2022; 12:e054206. [PMID: 35545393 PMCID: PMC9096538 DOI: 10.1136/bmjopen-2021-054206] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 04/15/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this systematic review was to examine the effectiveness of pre-anaesthesia assessment clinics (PACs) in improving the quality and safety of perioperative patient care. DESIGN Systematic review. DATA SOURCES The electronic databases CINAHL Plus with Full Text (EBSCOhost), Medline and Embase (OvidSP) were systematically searched on 11 September 2018 and updated on 3 February 2020 and 4 February 2021. ELIGIBILITY CRITERIA The inclusion criteria for this study were studies published in English or Scandinavian language and scientific original research that included randomised or non-randomised prospective controlled studies. Additionally, studies that reported the outcomes from a PAC consultation with the patient present were included. DATA EXTRACTION AND SYNTHESIS Titles, abstracts and full texts were screened by a team of three authors. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies. Data extraction was performed by one author and checked by four other authors. Results were synthesised narratively owing to the heterogeneity of the included studies. RESULTS Seven prospective controlled studies on the effectiveness of PACs were included. Three studies reported a significant reduction in the length of hospital stay and two studies reported a significant reduction in cancellation of surgery for medical reasons when patients were seen in the PAC. In addition, the included studies presented mixed results regarding anxiety in patients. Most studies had a high risk of bias. CONCLUSION This systematic review demonstrated a reduction in the length of hospital stay and cancellation of surgery when the patients had been assessed in the PAC. There is a need for high-quality prospective studies to gain a deeper understanding of the effectiveness of PACs. PROSPERO REGISTRATION NUMBER CRD42019137724.
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Affiliation(s)
- Eirunn Wallevik Kristoffersen
- Department of Health and Nursing Science, University of Agder, Kristiansand/Grimstad, Norway
- Department of Anaesthesiology and Intensive Care, Sørlandet Hospital, Kristiansand, Norway
| | - Anne Opsal
- Department of Health and Nursing Science, University of Agder, Kristiansand/Grimstad, Norway
| | - Tor Oddbjørn Tveit
- Department of Health and Nursing Science, University of Agder, Kristiansand/Grimstad, Norway
- Department of Anaesthesiology and Intensive Care, Sørlandet Hospital, Kristiansand, Norway
- Department of Technology and e-Health, Sørlandet Hospital, Kristiansand, Norway
| | - Rigmor C Berg
- Divison for health services, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
| | - Mariann Fossum
- Department of Health and Nursing Science, University of Agder, Kristiansand/Grimstad, Norway
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Soncrant C, Neily J, Sum-Ping SJT, Wallace AW, Mariano ER, Leissner KB, Mills PD, Mazzia L, Paull DE. Sharing Lessons Learned to Prevent Adverse Events in Anesthesiology Nationwide. J Patient Saf 2021; 17:e343-e349. [PMID: 31135598 DOI: 10.1097/pts.0000000000000616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Veterans Health Administration (VHA) lessons learned process for Anesthesia adverse events was developed to alert the field to the occurrences and prevention of actual adverse events. This article details this quality improvement project and perceived impact. METHODS As part of ongoing quality improvement, root cause analysis related to anesthesiology care are routinely reported to the VHA National Center for Patient Safety. Since May 2012, the National Anesthesia Service subject matter experts, in collaboration with National Center for Patient Safety, review actual adverse events in anesthesiology and detailed lessons learned are developed. A survey of anesthesiology chiefs to determine perceived usefulness and accessibility of the project was conducted in April 2018. RESULTS The distributed survey yielded a response rate of 69% (84/122). Most of those who have seen the lessons learned (85%, 71/84) found them valuable. Ninety percent of those aware of the lessons learned (64/71) shared them with staff and 75% (53/71) reported a changed or reinforced patient safety behavior in their facility. The lessons learned provided 72% (51/71) of chiefs with new knowledge about patient safety and 75% (53/71) gained new knowledge for preventing adverse events. CONCLUSIONS This nationwide VHA anesthesiology lessons learned project illustrates the tenets of a learning organization. implementing team and systems-based safeguards to mitigate risk of harm from inevitable human error. Sharing lessons learned provides opportunities for clinician peer-to-peer learning, communication, and proactive approaches to prevent future similar errors.
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Affiliation(s)
- Christina Soncrant
- From the Veterans' Health Administration, National Center for Patient Safety, Field Office, White River Junction, Vermont
| | - Julia Neily
- From the Veterans' Health Administration, National Center for Patient Safety, Field Office, White River Junction, Vermont
| | | | | | | | - Kay B Leissner
- Veterans Affairs Boston Healthcare System, Boston Massachusetts
| | | | - Lisa Mazzia
- Veterans' Health Administration, National Center for Patient Safety, Ann Arbor, Michigan
| | - Douglas E Paull
- Veterans' Health Administration, National Center for Patient Safety, Ann Arbor, Michigan
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Patient safety and the role of the Helsinki Declaration on Patient Safety in Anaesthesiology: A European survey. Eur J Anaesthesiol 2020; 36:946-954. [PMID: 31268913 DOI: 10.1097/eja.0000000000001043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND 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. OBJECTIVE To explore the role of the Helsinki Declaration in promoting and maintaining patient safety in European anaesthesiology. DESIGN Online survey. SETTING A total of 38 countries within Europe. PARTICIPANTS Members of the European Society of Anaesthesiology who responded to an invitation to take part by electronic mail. MAIN OUTCOME MEASURES Responses from a 16-item online survey to explore each member anaesthesiologist's understanding of the Declaration and compliance with its standards. RESULTS 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. CONCLUSION 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.
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de Santana Lemos C, de Brito Poveda V. Adverse Events in Anesthesia: An Integrative Review. J Perianesth Nurs 2019; 34:978-998. [PMID: 31005390 DOI: 10.1016/j.jopan.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 02/16/2019] [Accepted: 02/23/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE This study conducted an integrative review of the literature in a search for scientific evidence related to the occurrence of perioperative adverse events resulting from anesthesia. DESIGN Integrative review. METHODS The search was performed in the PubMed/MEDLINE, Virtual Health Library, Cumulative Index to Nursing and Allied Health, and Web of Science databases and portals, including studies published in Portuguese, English, or Spanish, from 1997 to 2017. The studies were supposed to assess adverse events associated exclusively with anesthesia care. FINDINGS We selected 21 studies. The main adverse events in anesthesia were respiratory, drug error, cardiology, and neurology. Most of the events were related to human errors, slips, and lapses that resulted in damage to the patient, such as permanent injuries or death. CONCLUSIONS Care planning, efficient communication, and teamwork are critical to prevent adverse events in anesthesia.
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Neily J, Silla ES, Sum-Ping SJT, Reedy R, Paull DE, Mazzia L, Mills PD, Hemphill RR. Anesthesia Adverse Events Voluntarily Reported in the Veterans Health Administration and Lessons Learned. Anesth Analg 2018; 126:471-477. [PMID: 28678068 DOI: 10.1213/ane.0000000000002149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anesthesia providers have long been pioneers in patient safety. Despite remarkable efforts, anesthesia errors still occur, resulting in complications, injuries, and even death. The Veterans Health Administration (VHA) National Center of Patient Safety uses root cause analysis (RCA) to examine why system-related adverse events occur and how to prevent future similar events. This study describes the types of anesthesia adverse events reported in VHA hospitals and their root causes and preventative actions. METHODS RCA reports from VHA hospitals from May 30, 2012, to May 1, 2015, were reviewed for root causes, severity of patient outcomes, and actions. These elements were coded by consensus and analyzed using descriptive statistics. RESULTS During the study period, 3228 RCAs were submitted, of which 292 involved an anesthesia provider. Thirty-six of these were specific to anesthesia care. We reviewed these 36 RCA reports of adverse events specific to anesthesia care. Types of event included medication errors (28%, 10), regional blocks (14%, 5), airway management (14%, 5), skin integrity or position (11%, 4), other (11%, 4), consent issues (8%, 3), equipment (8%, 3), and intravenous access and anesthesia awareness (3%, 1 each). Of the 36 anesthesia events reported, 5 (14%) were identified as being catastrophic, 10 (28%) major, 12 (34%) moderate, and 9 (26%) minor. The majority of root causes identified a need for improved standardization of processes. CONCLUSIONS This analysis points to the need for systemwide implementation of human factors engineering-based approaches to work toward further eliminating anesthesia-related adverse events. Such actions include standardization of processes, forcing functions, separating storage of look-alike sound-alike medications, limiting stock of high-risk medication strengths, bar coding medications, use of cognitive aids such as checklists, and high-fidelity simulation.
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Affiliation(s)
- Julia Neily
- From the Veterans Health Administration (VHA) National Center for Patient Safety (NCPS), White River Junction, Vermont
| | - Elda S Silla
- From the Veterans Health Administration (VHA) National Center for Patient Safety (NCPS), White River Junction, Vermont
| | - Sam John T Sum-Ping
- National Anesthesia Service, US Department of Veterans Affairs, Washington, DC.,Department of Anesthesiology and Pain Management, the University of Texas Southwestern Medical Center, Dallas, Texas.,Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Roberta Reedy
- Department of Anesthesiology, VHA, Seattle, Washington
| | - Douglas E Paull
- Veterans Health Administration (VHA) National Center for Patient Safety (NCPS), Ann Arbor, MI.,Georgetown University School of Medicine, Washington, DC
| | - Lisa Mazzia
- Veterans Health Administration (VHA) National Center for Patient Safety (NCPS), Ann Arbor, MI
| | - Peter D Mills
- Department of Psychiatry, the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,From the Veterans Health Administration (VHA) National Center for Patient Safety (NCPS), White River Junction, Vermont
| | - Robin R Hemphill
- Veterans Health Administration (VHA) National Center for Patient Safety (NCPS), Ann Arbor, MI
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Abstract
BACKGROUND In June 2010, the Helsinki Declaration was passed. As a result, an online nationwide critical incident reporting system named CIRSmedical Anaesthesiology (CIRSains) was implemented in Germany. The aim of the article is to evaluate CIRSains for practicability and to provide solutions to the problems detected during evaluation. METHODS Every medical staff member could take part voluntarily. Data were deidentified. All reports for anesthesiology (1548) were taken into account. Data collection lasted from April 2010 to February 2011. Incident report forms were classified according to World Health Organization and National Patient Safety Agency taxonomy. RESULTS Most reports (1347; 87.0%) contained American Society of Anaesthesiologists (ASA) classification, stratifying the severity of patients' underlying disease. Only some mentioned patients' age, even less sex. Physicians filed more reports than nurses. Staff-related factors constituted 794 (51.3%) choices, with attention issues (433; 28.0%) and routine violations (143; 9.2%) leading. Clinical processes (443; 28.6%), medication (347; 22.4%), and medical devices (530; 34.2%) were the leading incident category types. Most consequences ranged in low (398; 25.7%) and moderate (826; 53.4%) risk categories. Mitigating factors were barely mentioned. CONCLUSION CIRSains displays the German effort to establish the Helsinki declaration. Easy accessibility, anonymity, medicolegal safety, and high flexibility resulted in high usage. The study shows a sufficient practicability of the database, but the data input has to be improved for better scientific use, for example, by implementation of more multiple-choice questions. Given the high magnitude and importance of patient safety problems, improving CIRSains remains a priority for the future.
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Chawla R, Gupta A, Gupta A, Kumar M. Laryngoscope decontamination techniques: A survey. J Anaesthesiol Clin Pharmacol 2016; 32:99-102. [PMID: 27006551 PMCID: PMC4784224 DOI: 10.4103/0970-9185.175706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background and Aims: India is a vast country with variable, nonuniform healthcare practices. A laryngoscope is an important tool during general anesthesia and resuscitation. The study aimed to determine the current practices of laryngoscope decontamination in India. Material and Methods: An online survey was conducted amongst 100 anesthesiologists to determine the common methods of laryngoscope decontamination adopted in their settings. The survey was done over 6 months after validating the questionnaire. Results: A total of 73 responses were received out of 100. The result of the survey revealed that there is no uniform technique of laryngoscope decontamination. There is marked variability in techniques followed not only among different institutions, but also within the same institution. Conclusion: There are no fixed protocols adopted for laryngoscope decontamination. Thus, there is a need to develop definitive guidelines on this subject, which can be implemented in India.
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Affiliation(s)
- Rajiv Chawla
- Department of Anaesthesia, G. B. Pant Hospital, New Delhi, India
| | - Akhilesh Gupta
- Department of Anaesthesia, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Anshu Gupta
- Department of Anaesthesia, Lady Hardinge Medical College, New Delhi, India
| | - Mritunjay Kumar
- Ex-Department of Anaesthesia, G. B. Pant Hospital, New Delhi, India
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Reporting critical incidents in a tertiary hospital: a historical cohort study of 110,310 procedures. Can J Anaesth 2015; 62:1248-58. [PMID: 26407581 PMCID: PMC4644187 DOI: 10.1007/s12630-015-0492-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/06/2015] [Accepted: 09/11/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose Investigation of adverse events associated with anesthetic procedures is a method of quality control that identifies topics to improve clinical care and patient safety. Most research to date has been based on closed claim registries and anonymous reports which have specific limitations. Therefore, to evaluate a hospital’s reporting system, the present study was designed to describe critical incidents that anesthesiologists voluntarily and non-anonymously reported through an anesthesia information management system. Methods This is a historical observational cohort study on patients (age > 18 yr) undergoing anesthetic procedures in a tertiary referral hospital. A 20-item list of complications, as developed by the Netherlands Society of Anesthesiologists, was prospectively completed for each procedure. All critical incidents registered in the anesthesia information management system were then reclassified into 95 different critical incidents in a reproducible way. Results There were 110,310 procedures performed in 65,985 patients, and after excluding 158 reports that did not depict a critical incident, 3,904 critical incidents in 3,807 (3.5%) anesthetic procedures remained. Technical difficulties with regional anesthesia (n = 445; 40 per 10,000 anesthetics; 95% confidence interval [CI], 36 to 44), hypotension (n = 432; 39 per 10,000 anesthetics; 95% CI, 35 to 43), and unexpected difficult intubation (n = 216; 20 per 10,000 anesthetics; 95% CI, 18 to 23) were the most frequently documented critical incidents. Conclusion Accurate measurement and monitoring of critical incidents is crucial for patient safety. Despite the risk of underreporting and probable misclassification of manual reporting systems, our results give a comprehensive overview on the occurrence of voluntarily reported anesthesia-related critical incidents. This overview can direct development of a new reporting system and preventive strategies to decrease the future occurrence of critical incidents.
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The checklist: A standard of care. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rcae.2013.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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The checklist: A standard of care☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1097/01819236-201341030-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Sevdalis N, Hull L, Birnbach D. Improving patient safety in the operating theatre and perioperative care: obstacles, interventions, and priorities for accelerating progress. Br J Anaesth 2012; 109 Suppl 1:i3-i16. [DOI: 10.1093/bja/aes391] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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The checklist: A standard of care☆: La lista de chequeo: un estándar de cuidado. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1097/01819236-201241030-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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