The nuclear power industry as an alternative analogy for safety in anaesthesia and a novel approach for the conceptualisation of safety goals

Abstract

SummarySafety practices in health care have not kept pace with the increasing complexity of medical technology. Although anaesthesia is generally considered to be a leader in the improvement of patient safety, more powerful safety strategies must be found and employed. From an analysis of system characteristics, the nuclear power industry is proposed as an alternative analogy for safety in anaesthesia, and a novel diagrammatic approach is developed for the conceptualisation of safety goals. The nuclear power industry has spent vastly more time and money than has health care on the development of safety, and has progressed through significant safety milestones approximately three times more quickly than has anaesthesia. The greatest scope for the improvement of safety in anaesthesia lies in the appropriate re-design of medical systems and the lowering of the threshold for the reporting of incidents to include accident precursors, thus allowing the identification of dangerous systems before accidents occur.

Clinical assessment of a new anaesthetic drug administration system: a prospective, controlled, longitudinal incident monitoring study*

“…The new system is based on empirical data as well as theoretical considerations [6,16,19,[25][26][27]. We have previously evaluated it in a simulator and in a small randomised clinical trial [7,28].…”

A response to ‘The nuclear power industry as an alternative analogy for safety in anaesthesia and a novel approach for the conceptualisation of safety goals’

“…A response to 'Low-skill fibreoptic intubation: use of the Aintree Catheter with the classic LMA ' We read with concern the article by Higgs et al [1] concerning low-skill fibreoptic intubation using the Aintree catheter and classic laryngeal mask airway. Although we agree that this technique may be of merit in rescuing an unanticipated difficult intubation, we have concerns regarding some of the series described.…”

“…We agree with Dr Powell that patients should not present for vascular surgery without appropriate pre-operative preparation. However, although it is suggested that all patients presenting for vascular surgery should be considered for statin therapy [1], only half of elective abdominal aortic aneurysm (AAA) surgery patients receive statins [2]. The cardiac outcome of major vascular surgical patients may therefore be adversely affected by inadequate medical therapy.…”

“…Dr Webster [1] is entirely correct in stating that even when a system is redesigned so that no known system state can lead to disaster, disaster can still strike (if the system reaches an unknown state, in some cases a state unknown to the user). The possibility that the system will reach an unknown state is made smaller but not eliminated by risk management strategies.…”

Of humans, factors, failings and fixations

“…With an envious eye on the airline and nuclear industries, where there is a long tradition of attention to human factors going back decades [4,5], those who organise and work in the medical field are starting to catch up, albeit in fits and starts. Thus in the UK in recent years, the Chief Medical Officer and Department of Health (DoH) have repeatedly called for attention to human factors and the need to learn from other industries to prevent failings in the NHS [6][7][8] 1 -apparently with good results in terms of improving the 'safety culture' and moving away from blaming individuals [9] (though those at the coalface may beg to differ [10]).…”