Go/no-go decision in anaesthesia: wide variation in risk tolerance amongst anaesthetists

Greig, Paul; Higham, Helen; Darbyshire, Julie; Vincent, Charles

doi:10.1093/bja/aew444

Cited by 15 publications

(12 citation statements)

References 18 publications

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“…16 The qualitative method used was a 'go / no-go' decision-making scenario approach previously utilised in aviation and healthcare. 17,18 Participants were presented with scenarios, each describing a single risk factor in the context of tractor use. Participants indicate if they would proceed with the task (go) or not (no-go) and then present their reasoning.…”

Section: Aimmentioning

confidence: 99%

“…Scenarios were constructed based on guidelines to safe tractor use, avoidance of hazards by the HSE 16 and research indicating potential factors that could influence driver performance. 14 The style of each scenario adhered to the recommended structure for a go/nogo scenario within aviation and healthcare 17,18 whereby each scenario was short (maximum two sentences) and described a task based on real-life to provide context. For example, the scenario detailing tiredness was as follows: 'You have had a busy weekend on the farm and didn't get to bed last night until 5am.…”

Section: Questionnairementioning

confidence: 99%

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Investigation of UK Farmer Go/No-Go Decisions in Response to Tractor-Based Risk Scenarios

Irwin

Poots

2018

Journal of Agromedicine

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Section: Aimmentioning

confidence: 99%

Section: Questionnairementioning

confidence: 99%

Investigation of UK Farmer Go/No-Go Decisions in Response to Tractor-Based Risk Scenarios

Irwin

Poots

2018

Journal of Agromedicine

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“…In this environment of OBA the predominant technique used was TIVA. This technique is recommended for use by the service mainly for the logistical benefit of eliminating the need for gas scavenging 15 . The additional theoretical pharmacological benefits include that it does not trigger malignant hyperthermia and has a demonstrated lower rate of postoperative nausea and vomiting 16 .…”

Section: Discussionmentioning

confidence: 99%

A Clinical Audit of An Office-Based Anaesthesia Service for Dental Procedures in Victoria

Silvers

Licina²,

Jolevska³

2018

Anaesth Intensive Care

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There is an increasing number of specialties performing office-based procedures, with many different providers practising in this field. Office Based Anaesthesia Solutions is a private enterprise designed to be a high-quality general anaesthesia and sedation service delivering care across 18 dental practices in Victoria. We undertook a criterion-based audit of our practice standards and outcomes. Following ethics approval, we retrospectively reviewed consecutive patients managed by our service between March 2014 and July 2017. We collected demographic data, information about anaesthesia technique, and surgical features. We assessed our findings against the Australian and New Zealand College of Anaesthetists (ANZCA) day surgery policy documents. During the specified period, we provided anaesthesia or sedation for 1,323 patients. Their ages ranged from two to 93 years (mean [standard deviation] 33.3 [18.6] years). Ninety-three percent of patients were American Society of Anesthesiologists (ASA) physical status classification 1 or 2. Patient demographics were in line with ANZCA day surgical policy documents. Total intravenous anaesthesia was used in 1,054 of the 1,096 documented general anaesthesia cases. There were three unplanned hospital transfers (annual incidence 0.07%). As this was the first Australian criteria-based audit of officebased anaesthesia (OBA) for dental procedures, we cannot compare our findings directly to previous studies. However, we feel that our patient demographics fell within acceptable ANZCA day procedure standards and our adverse event rate was both very low and similar to other published international adverse event rates. Our audit indicates that with careful screening processes, patient selection and medical governance, OBA is a viable model of care for patients undergoing dental procedures.

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“…20 Introducing controls and restrictions can be an enormously powerful means of improving the safety of care. 21 However, in our experience, such controls are seldom formalised in LRS. Instead, it is often implicitly expected that health workers will attempt the impossible and take on tasks for which they are poorly trained and ill prepared.…”

Section: Task/work Focus Observations/experience Prioritisationmentioning

confidence: 99%

How to do no harm: empowering local leaders to make care safer in low-resource settings

et al. 2021

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In a companion paper, we showed how local hospital leaders could assess systems and identify key safety concerns and targets for system improvement. In the present paper, we consider how these leaders might implement practical, low-cost interventions to improve safety. Our focus is on making immediate safety improvements both to directly improve patient care and as a foundation for advancing care in the longer-term. We describe a ‘portfolio’ approach to safety improvement in four broad categories: prioritising critical processes, such as checking drug doses; strengthening the overall system of care, for example, by introducing multiprofessional handovers; control of known risks, such as only using continuous positive airway pressure when appropriate conditions are met; and enhancing detection and response to hazardous situations, such as introducing brief team meetings to identify and respond to immediate threats and challenges. Local clinical leaders and managers face numerous challenges in delivering safe care but, if given sufficient support, they are nevertheless in a position to bring about major improvements. Skills in improving safety and quality should be recognised as equivalent to any other form of (sub)specialty training and as an essential element of any senior clinical or management role. National professional organisations need to promote appropriate education and provide coaching, mentorship and support to local leaders.

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Go/no-go decision in anaesthesia: wide variation in risk tolerance amongst anaesthetists

Cited by 15 publications

References 18 publications

Investigation of UK Farmer Go/No-Go Decisions in Response to Tractor-Based Risk Scenarios

Investigation of UK Farmer Go/No-Go Decisions in Response to Tractor-Based Risk Scenarios

A Clinical Audit of An Office-Based Anaesthesia Service for Dental Procedures in Victoria

How to do no harm: empowering local leaders to make care safer in low-resource settings

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