Crises in clinical care: an approach to management
Open accessAbstract
A "crisis" in health care is "the point in the course of a disease at which a decisive change occurs, leading either to recovery or to death". The daunting challenges faced by clinicians when confronted with a crisis are illustrated by a tragic case in which a teenage boy died after a minor surgical procedure. Crises are challenging for reasons which include: presentation with non-specific signs or symptoms, interaction of complex factors, progressive evolution, new situations, "revenge effects", inadequate assistance, and time constraints. In crises, clinicians often experience anxiety- and overload-induced performance degradation, tend to use "frequency gambling", run out of "rules" and have to work from first principles, and are prone to "confirmation bias". The effective management of crises requires formal training, usually simulator-based, and ideally in the inter-professional groups who will need to function as a team. "COVER ABCD-A SWIFT CHECK" is a pre-compiled algorithm which can be applied quickly and effectively to facilitate a systematic and effective response to the wide range of potentially lethal problems which may occur suddenly in anaesthesia. A set of 25 articles describing additional pre-compiled responses collated into a manual for the management of any crisis under anaesthesia has been published electronically as companion papers to this article. This approach to crisis management should be applied to other areas of clinical medicine as well as anaesthesia.
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Patient safety risks and incidents caused by problems with computer use are widely recognized as an unintended consequence of healthcare information technology.
“Patient safety risks and incidents caused by problems with the use of computers are now widely recognized as an unintended consequence of healthcare information technology (IT), 1e3 just as 'revenge effects' have been described after other system changes.4”
From An analysis of computer-related patient safety incidents to inform the development of a classification (2010) · cites this paper as [4]
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Sorted by citations
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Self-citation
- 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
- 156-163
- ISSN
- 1475-3898 (ISSN-L)
- 1475-3901
- PMC
- PMC1744000
- OpenAlex
- W2111332661
- Cited by
- 54
- References
- 56
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2022: 2 · 2021: 3 · 2020: 5 · 2019: 3 · 2018: 2 · 2016: 5 · 2014: 2 · 2013: 4 · 2012: 2
- FWCI
- 6.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ Quality & Safety (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- ResearchSpace (University of Auckland) (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 › Physiology › Simulation-Based Education in Healthcare
- Keywords
- crisis management, anesthesia, medical emergencies, simulation-based training, interprofessional collaboration, confirmation bias, surgical complications
- MeSH terms
- Algorithms, Anesthesia, Anesthesiology, Australia, Emergencies, Humans, Intraoperative Complications, Risk Management, Task Performance and Analysis, Monitoring, Intraoperative, Outcome Assessment, Health Care, Consensus
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