Volume 7, No. 2 • Summer 1992

“Practice Pressure” A Constant Threat to Patient Safety

Casey D. Blitt, M.D.

Has this scenario ever happened to you? You are running late, your referring surgeon is anxiously awaiting your presence, and your case assignment has suddenly been changed. You encounter a patient with multiple medical problems for whom you are requested to provide anesthesia care. The natural tendency and the pressure to “get the case going” inevitably results in your cutting corners in your pre-anesthetic assessment and construction of an anesthesia plan. Don’t let this happen.

Despite the potential consequences of such practice pressures and the impact on your relationship with referring physicians, hospital personnel, etc., do not yield to the temptation to .get the case going’ at any cost. You will most likely be doing yourself and more importantly the patient a disservice. The mental processes of the practice of anesthesiology and proper preparation for every anesthetic mandate that appropriate time and attention be devoted to each patient.

Granted that clinical urgency may dictate expediency, we must not lose sight of the fact that hasty evaluation and planning for an anesthetic has the potential to result in disastrous consequences. If and when you find yourself in such a situation, it is helpful to explain to all parties involved your concern for the appropriate evaluation and planning for anesthetic management. Even five or ten extra minutes for thoughtful preparation will result in better patient care, improved outcomes, and less potential need later for crisis management.

Virtually everyone understands the importance of thorough patient assessment and the resultant anesthetic plan with contingencies for unforeseen events. Do not let your ego or the surgeon’s insistence compromise this thoughtful process.

I share these thoughts with you because I have found myself in this situation on numerous occasions. I trust that my experience is not unique in the practice of anesthesia. I find that if I simply take a deep breath, refuse to succumb to the practice pressure, and perform an unhurried patient evaluation and formulate the resulting anesthetic plan, everyone benefits. When I have hurried and ‘cut corners,” I found myself in undesirable clinical scenarios. It is my opinion that inadequate evaluation and preparation for administration of an anesthetic is an occurrence we can all prevent, thereby improving patient care, patient outcome, and our own self satisfaction with a job well done.

Casey D. Blitt, M.D.

Old Publeo Anesthesia, Tuscon, AZ

Member of the APSF Board of Directors