A cross-sectional overview of the second 4000 incidents reported to webAIRS, a de-identified web-based anaesthesia incident reporting system in Australia and New Zealand

Abstract

This cross-sectional overview of the second 4000 incidents reported to webAIRS has findings that are very similar to the previous overview of the first 4000 incidents. The distribution of patient age, body mass index and American Society of Anesthesiologists physical status was similar, as was anaesthetist gender, grade, location and time of day of incidents. About 35% of incidents occurred during non-elective procedures (vs. 33% in the first 4000 incidents). The proportion of incidents in the various main categories was also similar, with respiratory/airway being most common, followed by cardiovascular, medication-related and medical device or equipment-related incidents. Together these categories made up about 78% of all incidents in both overviews. The immediate outcome was comparable with reports of harm in about a quarter of incidents and a similar rate of deaths (4.7% vs. 4.2%). However, the proportion of patients who had received total intravenous anaesthesia was higher (17.6% vs. 7.7%) and the proportion of patients who received combined intravenous and inhalational anaesthesia was lower (52.3% vs. 58.4%), as was the proportion receiving local anaesthesia alone (1.6% vs. 6.7%). There was a small increase in the number of incidents resulting in unplanned admission to a high dependency or intensive care unit (18.1% vs. 13.5%). It is not clear whether these differences represent trends or random observations. About 48% of incidents were considered preventable by the reporters (vs. 52% in the first 4000). These findings support continued emphasis on human and system factors to promote and improve patient safety in anaesthesia care.

Hypercarbia and high-flow nasal oxygen use during anaesthesia – risking a failure to thrive?

“…The ethics approval process for the webAIRS data collection methodology has previously been published. 14 It is briefly repeated here: webAIRS data collection complies with the current ethics requirements for the collection of de-identified quality assurance data in Australia, as outlined by the National Health and Medical Research Council (NHMRC). 15 In order to ensure data collection meets the NHMRC requirements ethics approval was been sought and obtained from two hospitals in Australia: Royal Brisbane and Women's Hospital Human Research Ethics Committee (HREC/11/QRBW/311) and Nepean Blue Mountains Local Health District (HREC/12/NEPEAN/18).…”

Analysis of anaesthesia incidents during caesarean section reported to webAIRS between 2009 and 2022

“…Incidents have been entered into the database since September 2009 and some data we are presenting have been previously analysed and published. 3 , 4 Data relating to clinical incidents are entered into the database, with no identifying clinician or patient details. Incidents range from difficult cases, near misses and workload issues, to significant clinical incidents with patient harm or death.…”

Incidents relating to paediatric regional anaesthesia in the first 8000 cases reported to webAIRS

“…The reports are confidential and protected by qualified privilege in both Australia and New Zealand. 6 Incidents affecting paediatric patients less than 17 years of age were extracted from the first 8000 reports to webAIRS. Additionally, incidents which did not directly categorise by patient age were scanned and added to the analysis if the written narrative described an age which fitted the inclusion criteria of less than 17 years.…”

“…An overview of the first and second 4000 incidents was published in 2017 and 2021, respectively, and de-identified data collection methods were described in detail. 5 , 6 Data are collected in compliance with the National Health and Medical Research Council 2014 recommendations for de-identified quality assurance data. In addition, multi-centre ethics approval is maintained by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee (HREC/11/QRBW/311) and the Nepean Blue Mountains Local Health District (HREC/12/NEPEAN/18).…”