This column is prompted by a recent Twitter conversation that was part of a thread based on a previous blog post in which I contrasted the systems approach used for airline safety with the lack of same in many hospitals. Warning: You are about to read gross generalizations and stereotypes!
Carolyn Johnston, @DRCJohn, and Barbara Nelson, @SafetyNurse, made the point:
Aviation emulated successfully in anaesthesia, w 1 of best#ptsafety records http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117775/ …”
This prompted me to ask:
Yes, anaesthesia has led the safety movement--so why can't they help eliminate wrong site surgeries?
Perhaps it is because they are not attuned to crew resource mgmt and how to bring it abt in the ORs.
Perhaps they are overly deferential to the surgeons & revert to passivity in the face of aggression.
To which Dermot O'Riordon, @dermotor, (Surgical/Med Director in Suffolk, UK) replied:
"Overly deferential to surgeons"? You must know v different anaesthetists to those I work with!
I was being lighthearted in my last comment, but a serious question remains, and I'd like to use this post to challenge anaesthesiologists out there to give a good answer.
As I noted above, anaesthesiologists have led the safety movement in hospitals. They introduced many innovations into their own practice--in terms of procedures, equipment safety, and simulation training. I have found them, too, to be devoted to the science of process improvement, both in operating room settings and in critical care. I've also found them to be modest about what they know and what they don't know, always looking to improve their own skills and the work environment. Finally, many are excellent teachers. In short, an exemplary group of doctors. Indeed, they have gotten so good at what they do and cause so little harm that malpractice insurance rates for the profession have dropped and are quite reasonable compared to other specialists. As noted here:
Decreasing anesthesiologist malpractice premiums reflect the decrease in the number of catastrophic anesthesia claims for esophageal intubation, death, and brain death.
In 1985, the average malpractice insurance premium was $36,224 per year for a $1 Million per claim/$3 Million per year policy. By 2009, this decreased to $21,480, a striking 40% drop.
The take-home message is that anesthesia has serious risks, but those risks have decreased significantly in recent years because of improvements in monitoring and education. Compared to other specialties, the risk of an anesthesiologist being sued is about average among American medical specialties.
Notwithstanding that, as we have discussed, the number of wrong site surgeries and other procedures in the US remains remarkably constant. There is a clear pre-surgical protocol that is well developed that should be followed in every case to prevent this, but it is not always followed. As I noted:
The simple truth is that many doctors don't buy in to this. I've heard of some anaesthesia writings that cite the statistics indicating the errors continue as evidence that the checklist protocol does not work! These observers completely ignored whether the protocol was actually being followed or not.
My question is this: Recognizing that the surgeon is the "pilot of the ship" in the OR, the anaesthesiologist has a critically important role in every case. Why isn't this profession taking on the advocacy role for full and complete implementation of the pre-surgical checklist? Beyond this, why doesn't this profession insisting on teaching crew resource management in the high pressure surgical environment. In short, why isn't anaesthesia as a profession driving the broader kind of process improvement for which it has become legend in its own arena?
Standing by for your answers.
Carolyn Johnston, @DRCJohn, and Barbara Nelson, @SafetyNurse, made the point:
Aviation emulated successfully in anaesthesia, w 1 of best
This prompted me to ask:
Yes, anaesthesia has led the safety movement--so why can't they help eliminate wrong site surgeries?
Perhaps it is because they are not attuned to crew resource mgmt and how to bring it abt in the ORs.
Perhaps they are overly deferential to the surgeons & revert to passivity in the face of aggression.
To which Dermot O'Riordon, @dermotor, (Surgical/Med Director in Suffolk, UK) replied:
"Overly deferential to surgeons"? You must know v different anaesthetists to those I work with!
I was being lighthearted in my last comment, but a serious question remains, and I'd like to use this post to challenge anaesthesiologists out there to give a good answer.
As I noted above, anaesthesiologists have led the safety movement in hospitals. They introduced many innovations into their own practice--in terms of procedures, equipment safety, and simulation training. I have found them, too, to be devoted to the science of process improvement, both in operating room settings and in critical care. I've also found them to be modest about what they know and what they don't know, always looking to improve their own skills and the work environment. Finally, many are excellent teachers. In short, an exemplary group of doctors. Indeed, they have gotten so good at what they do and cause so little harm that malpractice insurance rates for the profession have dropped and are quite reasonable compared to other specialists. As noted here:
Decreasing anesthesiologist malpractice premiums reflect the decrease in the number of catastrophic anesthesia claims for esophageal intubation, death, and brain death.
In 1985, the average malpractice insurance premium was $36,224 per year for a $1 Million per claim/$3 Million per year policy. By 2009, this decreased to $21,480, a striking 40% drop.
The take-home message is that anesthesia has serious risks, but those risks have decreased significantly in recent years because of improvements in monitoring and education. Compared to other specialties, the risk of an anesthesiologist being sued is about average among American medical specialties.
Notwithstanding that, as we have discussed, the number of wrong site surgeries and other procedures in the US remains remarkably constant. There is a clear pre-surgical protocol that is well developed that should be followed in every case to prevent this, but it is not always followed. As I noted:
The simple truth is that many doctors don't buy in to this. I've heard of some anaesthesia writings that cite the statistics indicating the errors continue as evidence that the checklist protocol does not work! These observers completely ignored whether the protocol was actually being followed or not.
My question is this: Recognizing that the surgeon is the "pilot of the ship" in the OR, the anaesthesiologist has a critically important role in every case. Why isn't this profession taking on the advocacy role for full and complete implementation of the pre-surgical checklist? Beyond this, why doesn't this profession insisting on teaching crew resource management in the high pressure surgical environment. In short, why isn't anaesthesia as a profession driving the broader kind of process improvement for which it has become legend in its own arena?
Standing by for your answers.
0 comments:
Post a Comment