Crises in clinical care: an approach to management

Anaesthetists' management of oxygen pipeline failure: room for improvement*

“…There is a recognised need for precompiled responses to crises [8] but currently available crisis management algorithms do not adequately address the problem of oxygen pipeline supply failure. For example, Gaba et al [9] outline a response to oxygen supply failure but do not fully address the need for conservation of oxygen, or the issue of reconnection of a previously disrupted pipeline.…”

“…For example, Gaba et al [9] outline a response to oxygen supply failure but do not fully address the need for conservation of oxygen, or the issue of reconnection of a previously disrupted pipeline. The Australian Incident Monitoring group (AIMS) developed a list of precompiled responses to crises in anaesthesia, based on their extensive database of critical incidents [8] but did not include gas pipeline failure.…”

Maintenance of anaesthesia

“…In a crisis, performance may be impaired by anxiety, workload, time pressure and the presence of a complex situation not encountered before. 7 Anaesthetists encounter such situations infrequently so are often poorly equipped to deal with them. The simulation of situations and knowledge of precompiled responses (e.g.…”

The effects Of cognitive aids On formation and functioning Of teams in medical emergencies

“…As a result, the team member may have more time to allocate to managing the team during the crisis (Runciman & Merry, 2005). In the case of a team leader this may translate into more effective resource allocation, prioritising and decisionmaking.…”

“…Complex critical care emergencies seemed to be the ideal setting to observe team performance for five main reasons (Runciman & Merry, 2005): (a) there are commonly a large number of team members with different backgrounds involved in the emergency who need to act in a coordinated fashion, (b) during the emergency there are many actions that need to be remembered, often in a specified order, (c) emergencies are typically rare and as a result the required actions are often forgotten and there is little opportunity to practice, (d) there is usually an associated time pressure that increases the levels of stress on the team members making it more likely that they will omit an action, perform an incorrect action or fail to coordinate with others, and (e) there is an emerging body of literature regarding team performance in critical care emergencies. In addition, my experience in anaesthesia and simulation training for critical care emergencies made this the ideal setting.…”