Systems safety in nonoperating room anesthesia locations

Abstract

Purpose of reviewNonoperating room anesthesia (NORA) care is an area of rapid growth over the last decade. However, literature describing safety systems in NORA is limited. This review evaluates historical safety models described by Donabedian and Reason, assesses the NORA environment and safety concerns that may contribute to adverse events, and provides potential solutions via a human-centered systems safety design. Recent findingsSystems Engineering Initiative for Patient Safety (SEIPS) 3.0 provides a framework for quality and patient safety improvement. Although the previous SEIPS 2.0 model has been used to evaluate NORA environments with focus on the case volume, high productivity pressure, and significant physical constraints common to NORA sites, literature describing SEIPS 3.0 in relation to NORA care is sparse. Given the rate of malpractice claims for death in NORA settings, solutions that address the multifactorial nature of adverse events are needed.

Time Out: The Impact of Physician Burnout on Patient Care Quality and Safety in Perioperative Medicine

“…Despite the priority on perioperative quality and safety, errors can still occur. 23 Unfortunately, those devastating errors can lead to “second victim syndrome.” 46,47 Additionally, the authors observed that the industrial-like metrics for productivity, 48 efficiency, 49 long hours, extensive shifts, 50 and cost cutting with increased perioperative throughput add another dimension of complexity and stress to perioperative physicians, increasing their likelihood of burnout.…”

Management of anesthetic complications outside the operating room

“…Shaping and directing NORA from a systems and processes standpoint may preempt complications and can foster high reliability in varying environments [6,36]. Building relationships and productive communication with proceduralists, procedure staff, and hospital administration are essential to successful implementation of systems safety initiatives in a collaborative environment.…”

The Infinite Game: One Possible Future of Anesthesia in the United States

“…7 Microaggressions, role ambiguity, and stereotyping can contribute to stress, anxiety, burnout, 8 and an associated deterioration of team-based anesthesia care. 9 Is it wise, then, to dig deeper into a political and financial battle that can undermine the patient care we provide? Further, what happens if one "side" chooses to adopt an infinite mindset while the other continues its current finite game approach?…”