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Cited by 92Patient Safety and Medication ErrorsClinical Reasoning and Diagnostic SkillsCardiac Arrest and Resuscitation

Crisis management during anaesthesia: the development of an anaesthetic crisis management manual

Open access
Runciman, W B·2005·Quality and Safety in Health Care
DOI 10.1136/qshc.2002.004101PMC PMC1744021
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Abstract

BACKGROUND: All anaesthetists have to handle life threatening crises with little or no warning. However, some cognitive strategies and work practices that are appropriate for speed and efficiency under normal circumstances may become maladaptive in a crisis. It was judged in a previous study that the use of a structured "core" algorithm (based on the mnemonic COVER ABCD-A SWIFT CHECK) would diagnose and correct the problem in 60% of cases and provide a functional diagnosis in virtually all of the remaining 40%. It was recommended that specific sub-algorithms be developed for managing the problems underlying the remaining 40% of crises and assembled in an easy-to-use manual. Sub-algorithms were therefore developed for these problems so that they could be checked for applicability and validity against the first 4000 anaesthesia incidents reported to the Australian Incident Monitoring Study (AIMS). METHODS: The need for 24 specific sub-algorithms was identified. Teams of practising anaesthetists were assembled and sets of incidents relevant to each sub-algorithm were identified from the first 4000 reported to AIMS. Based largely on successful strategies identified in these reports, a set of 24 specific sub-algorithms was developed for trial against the 4000 AIMS reports and assembled into an easy-to-use manual. A process was developed for applying each component of the core algorithm COVER at one of four levels (scan-check-alert/ready-emergency) according to the degree of perceived urgency, and incorporated into the manual. The manual was disseminated at a World Congress and feedback was obtained. RESULTS: Each of the 24 specific crisis management sub-algorithms was tested against the relevant incidents among the first 4000 reported to AIMS and compared with the actual management by the anaesthetist at the time. It was judged that, if the core algorithm had been correctly applied, the appropriate sub-algorithm would have been resolved better and/or faster in one in eight of all incidents, and would have been unlikely to have caused harm to any patient. The descriptions of the validation of each of the 24 sub-algorithms constitute the remaining 24 papers in this set. Feedback from five meetings each attended by 60-100 anaesthetists was then collated and is included. CONCLUSION: The 24 sub-algorithms developed form the basis for developing a rational evidence-based approach to crisis management during anaesthesia. The COVER component has been found to be satisfactory in real life resuscitation situations and the sub-algorithms have been used successfully for several years. It would now be desirable for carefully designed simulator based studies, using naive trainees at the start of their training, to systematically examine the merits and demerits of various aspects of the sub-algorithms. It would seem prudent that these sub-algorithms be regarded, for the moment, as decision aids to support and back up clinicians' natural responses to a crisis when all is not progressing as expected.

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  • Incident reports do not yield true frequencies of errors or adverse events because they do not capture numerators or denominators, and are subject to bias from a number of sources.

    “It is important to note that incident reports do not yield true frequencies of errors or adverse events because they do not capture numerators or denominators, and are subject to bias from a number of sources.22”

    From An analysis of computer-related patient safety incidents to inform the development of a classification (2010) · cites this paper as [22]

  • The incidents studied are based on self-reports provided to a voluntary incident reporting system, with inherent limitations such as a bias toward reporting incidents which appear interesting or unusual.

    “The incidents studied here are based on self-reports provided to a voluntary incident reporting system, with all the inherent limitations of such a system, such as a bias toward reporting incidents which appear interesting or unusual.22”

    From An analysis of computer-related patient safety incidents to inform the development of a classification (2010) · cites this paper as [22]

  • Incident reports are useful in providing a profile of the nature of the problems encountered, and this profile has generally been shown to be consistent until interventions are introduced.

    “As we have shown in other domains, such incident reports are useful in providing a profile of the nature of the problems encountered, and this profile has generally been shown to be consistent until interventions are introduced to address problems identified.22”

    From An analysis of computer-related patient safety incidents to inform the development of a classification (2010) · cites this paper as [22]

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Research works printed but not linked: 2

  1. Runciman, Kluger, Morris, et al www.qshc.com on May 29, 2023 by guest. Protected by copyright. http://qualitysafety.bmj.com/ Qual Saf Health Care: first published as 10.1136/qshc.2002.004101 on 2 June 2005. Downloaded from Runciman, Kluger, Morris, et al www.qshc.com on May 29, 2023 by guest. Protected by copyright. http://qualitysafety.bmj.com/ Qual Saf Health Care: first published as 10.1136/qshc.2002.004101 on 2 June 2005. Downloaded from REFERENCES
  2. Reason JT. Human error. New York: Cambridge University Press, 1990.

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Authors
Runciman, W. B.
Affiliations
Royal Adelaide Hospital (AU)
Corresponding author
Runciman, W B
ORCID
Runciman, W B
Venue
Quality and Safety in Health Care
Publisher
BMJ
Published
2005-06-01
Volume
14
Issue
3
Pages
e1-e1
ISSN
  • 1475-3898 (ISSN-L)
  • 1475-3901
DOI
10.1136/qshc.2002.004101
PMC
PMC1744021
OpenAlex
W1975511610
Cited by
92
References
65
Citations by year
2026: 1 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 4 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 4 · 2016: 6 · 2015: 6 · 2014: 4 · 2013: 5 · 2012: 5
FWCI
15.42
Type
journal article
Language
en
Open access
Locations
  • BMJ Quality & Safety (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Topics
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
Keywords
patient safety, simulation-based training, manual development, evidence-based practice, resuscitation, airway management, hemodynamic instability, hypotension management
MeSH terms
Algorithms, Anesthesiology, Australia, Emergencies, Humans, Intraoperative Complications, Manuals as Topic, Resuscitation, Risk Management, Task Performance and Analysis, Monitoring, Intraoperative, Practice Guidelines as Topic, Consensus

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