A Focus On: Perioperative Quality and Safety


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Anesthesiologists were among the first to adopt human factors, industrial engineering, and operations research as part of clinical practice. Large, interprofessional teams with varying levels of training care for patients in the perioperative environment. Patients who may have multiple comorbidities are subjected to a variety of physiologic stresses during surgery. At any time, one or more factors, including patient illness, the surgical procedure, or equipment malfunction, may combine to cause a life threatening condition. Although accidents and “near misses” in the operating room are relatively uncommon on an individual scale, thousands of adverse events occur throughout the United States each year.

Deviations from safe practice can be classified as errors or violationsErrors are unintentional and can be caused by unfamiliarity with a given task, external pressures such as production pressure, or systemic problems such as a poor human-system interface or fatigue due to extended work hours. Systemic failures, or latent errors, include problems such as poor equipment design, inadequate facilities, or a badly-designed procedure, and may go undetected for months or years. A violation is a deliberate deviation from safe practice, and is usually the result of an attempt to achieve a goal that is incompatible with safe practice. Although it is tempting to dismiss violations as the actions of “someone else,” even the most dedicated physician may deviate from safe practice if, for example, a poorly-designed clinical procedure gets in the way of patient care.

Research in the fields of safety and human factors continues to evolve, and current interests include the early detection of error-producing situations and the design of error-resistant systems. Safety Management (SMS) is a systematic, comprehensive process that integrates risk management, safety, and knowledge sharing into the entire organization’s workflow. Already widely used in aviation and other high-reliability industries, SMS encourages analysis of accidents and near-misses, integrating the lessons learned into safety policy and risk management procedures. SMS uses frequent communication, training, and dissemination of critical information to create a positive safety culture. Using tools for risk assessment, judgment, and decision-making may help to improve patient safety in the perioperative period.

Keith Ruskin is Professor of Anesthesiology at the University of Chicago. His published work includes Anesthesia Emergencies 2nd edition (available in print and online) and Fundamentals of Neuroanesthesia (print and online). His book, Quality and Safety in Anesthesia and Perioperative Care, is due to publish in November 2016.

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