From the Literature: Safety-Related Papers Summarized

Fred Orkin, M.D.

A survey of the recent literature relevant to anesthesia safety yielded the following citations and brief descriptions:

1. Gerteis M. Edgman-Levitan S. Daley J, Delbanco TL (eds): Through the Patient’s Eyes: Understanding and Promoting Patient-Centered Care. San Francisco, Jossey-Bass, 1993 Hardcover, 317 pp (US $29.95). What do patients experience when they go to the hospital? This text summarizes the patients perspective based on a national survey of more than 6,000 patients after treatment in 62 U.S. hospitals, field visits to 20 hospitals, and associated focus groups. Seven dimensions of patient-centered care are described, with recommendations for dealing more effectively with them. Highlighted is the undertreatment of postoperative pain.

2. Banks IC, Tackley RM: A standard set of terms for critical incident recording? Br J Anaesth 1994; 73: 703-708. Anesthetic-related critical incidents are studied in many countries, but ‘many identical concepts, words and phrases … fare] often expressed or spelt differently, Ieading to duplication or confusion of the underlying phenomena. As a remedy, a comprehensive thesaurus of clinical terms is being developed for use in Britain’s Read Clinical Classifications to describe critical incidents more accurately and facilitate national registries. This is an activity within the British National Health Service to describe all aspects of clinical medicine within a computer-based data base.

3. Iezzoni LI (ed): Risk Adjustment for Measuring Health Outcomes. Ann Arbor (Ml): Health Administration Press, 1994 Softcover, 423 pp (US $41.00): This text summarizes the state-of-the-art in making adjustments for patient risk when making comparisons of patient outcomes across different treatment options and settings. Of note, ASA Physical Status Classification receives only passing mention as a ‘global subjective” measure of co-morbidity.

4. Leape LL: Error in medicine JAMA 1994; 272: 1851-1857. This is a masterful synthesis of the managerial, statistical, and engineering sciences’ perspectives on error and its prevention, as applied to health care. Leape leans heavily on psychological and human factors research, noting what has been learned about prevention in aviation and nuclear energy industries, how these concepts depart from the traditional approach in medicine, and what systems changes are needed in health care for error prevention. While misquoting temporal aspects, he attributes improvements in anesthesia care to the application of error prevention strategies.

5. Blumenthal D: Making medical errors in ‘medical treasures.’ JAMA 1994; 272: 1867-1968. A brief, but meaty editorial accompanying Leape’s paper on error urges adoption of the new sciences of quality management and error prevention, which rely on systems sciences and statistical process control, among other non-medical fields and methods. Without using the term kaizen, he emphasizes that each error presents an opportunity to devise new ways to improve care.

6. Walker IS (ed): Quality and Safety in Anaesthesia. London: BMJ Publishing Group, 1994 Softcover, 212 pp 19.00.: A British risk manager hosts his colleagues in anesthesiology, psychology, and risk management to present current reviews of such mainstream topics as quality management, the National CEPOD Study, lessons from aviation, anesthetic critical incidents, and the roles of computers, equipment design, patient monitoring, and practice standards in maintaining and enhancing quality in anesthesia care.

7. Warden IC, Borton CL, Horan BF: Mortality associated with anaesthesia in New South Wales, 1984-1990. Med J Aust 1994; 161: 585-593. Ongoing surveillance of deaths associated with anesthesia in New South Wales reports that the estimated rate of anesthesia-related deaths in the period 1984-90 was half that for 1970 and about a quarter that for 1960. In 11% of the deaths, there were contributing factors under the control of the anesthetist. Three quarters of the deaths involved abdominal, cardiothoracic or vascular surgery, with 70% relating to emergency procedures.

Dr. Orkin is from the Dartmouth-Hitchcock Medical Center and has long been an observer of personnel issues and complications in anesthesiology practice.

Editor’s note: Any other recent publications relevant to anesthesia patient safety not covered here deserve mention in this column Readers are invited to identify such publications in a note to the Editor (see Page 2, bottom right comer) and also, if desired, include a brief review (even up to 500 words) of the material.