A Time-out For Anesthesia Professionals

Anesthesiologists

“The single biggest problem in communication is the illusion that it has taken place.”

­—George Bernard Shaw

Promoting and establishing a health care safety culture is one of the foundations for better patient care.1 One particular factor, poor/inefficient or ineffective communication among health care workers continues to be an important cause of medical errors and potential adverse events, some with devastating consequences have been identified. Teamwork and proper communications have been identified as a key component for the successful management of complex tasks during critical times and crisis management. Standardized hand-off of patient information has been addressed extensively, but other communication issues have received less attention.2

Anesthetic and airway management issues during induction/emergence of anesthesia continue to be an important cause of severe morbidity and even mortality. When airway-related complications occur, the consequences can be irreversible and even catastrophic. Individual, team, and coordinated effective group efforts utilizing special equipment are needed to successfully deal with these high impact events that many times are unexpected.3,4

The World Health Organization (WHO), Association of periOperative Registered Nurses (AORN), and the Joint Commission have recommended pre- and post-procedure team briefings to attempt to encourage surgical team engagement, efficiency, safety, and team satisfaction by potentially improving communication of critical information before and after controversial and variable issues.5–7 There are still controversial and variable issues regarding these briefings: when, what information, and who must participate in them is not always clear cut. Some degree of variation and customization among institutions and services is allowed and expected, but the real question is whether we should allow key anesthetic issues to be left out of such group discussion opportunities. Many institutions do not mandate team briefings. Instead a pre-procedural time-out that can even occur after the anesthesia technique has been initiated, with the goal to determine correct patient identity, type of procedure, surgical site, and antibiotic prophylaxis, is performed. Many times no post-intervention debriefing is ever performed.

The absence of team briefings implies that critical events such as anesthesia induction and emergence with all airway-related matters that take place during procedures are not always being included as part of these team safety efforts. If these pauses/meetings are intended to promote effective teamwork, improve communication, enhance quality of care, and use them as an opportunity to decrease adverse medical events, then not implementing them, doing them in a hasty manner, or not including or discussing anesthetic-airway developments should be viewed as systemic issues and latent safety factors. We, as anesthesia professionals should strongly consider making anesthesia induction and emergence and its associated operations part of an organized “time-out.” We should voice our plans, concerns, and needs during safety team efforts, so that, in the event something unexpected or adverse occurs, the entire perioperative team is ready to give much-needed support and assistance without delays or hesitation.

 

Felipe Urdaneta, MD

Dr. Urdaneta is professor of Anesthesiology at University of Florida/ NFSGVHS and is an editorial board member of the APSF Newsletter.


Dr. Urdenta has no conflicts of interest as they relate to this article.


References

  1. Culture of safety. Available from: https://psnet.ahrq.gov/primers/primer/5/Culture-of-Safety Accessed August 19, 2019.
  2. Greenberg, S. Handoff communication: An APSF safety initiative and perioperative provider concern. APSF Newsletter. 2017;32:29–56. https://www.apsf.org/article/handoff-communication-an-apsf-safety-initiative-and-perioperative-provider-concern/ Accessed August 8, 2019
  3. Cook TM, Woodall N, Frerk C, et al. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia. British Journal of Anaesthesia. 2011;106:617–631.
  4. Metzner JM, Posner KL, Lam MS, Domino KB. Closed claims’ analysis. Best Practice Research Clinical Anaesthesiology. 2011;25:263–276.
  5. WHO guidelines for safe surgery: 2009: safe surgery saves lives. WHO/IER/PSP/2008.08-1E. Available from: https://www.who.int/patientsafety/safesurgery/tools_resources/9789241598552/en/ Accessed August 8, 2019.
  6. AORN Comprehensive Surgical Checklist. Available from: https://www.aorn.org/guidelines/clinical-resources/tool-kits/correct-site-surgery-tool-kit/aorn-comprehensive-surgical-checklist Accessed August 8, 2019.
  7. Safe Surgery Checklist. Available from: https://www.jointcommission.org/safe_surgery_checklist/ Accessed August 8, 2019.