Anaesthesia
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Multicenter Study
Techniques for identifying the epidural space: a survey of practice amongst anaesthetists in the UK.
A postal survey of all UK members of the Obstetric Anaesthetists' Association was carried out to ascertain their preferred method for identifying the epidural space in obstetric and non-obstetric patients. Over 1200 questionnaires were returned (79.3% response rate). In obstetric patients, the single most common technique (used by 58% of anaesthetists) was continuous advancement of the epidural needle and loss of resistance with saline, followed by intermittent needle advancement with air (21%). ⋯ Only 48% of anaesthetists said they would try an alternative if they experienced difficulty with their preferred technique. A similar pattern was seen for lumbar epidurals in non-obstetric surgical patients (89% used the same technique as in obstetrics), although for thoracic epidurals, 23% used a different technique to that which they would use for obstetrics, and the paramedian approach was more popular (21%). When inserting lumbar epidurals to supplement general anaesthesia in surgical patients, 18% of anaesthetists said they usually performed the block with the patient asleep, whereas for thoracic epidurals, this figure fell to 14%.
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The handover of patient information between shifts enables continuity of care and increases patient safety. We surveyed UK practice during handovers in obstetric anaesthesia. A questionnaire was sent to 239 lead consultant obstetric anaesthetists to record routine practice in their unit and individual opinion about handover procedures. ⋯ Consultant anaesthetists were most likely to be present at the morning handover and few handovers were multidisciplinary. Four percent of units reported critical incidents following inadequate handovers in the past 12 months. We identify features in handover procedures that could be improved.
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Multicenter Study
Involving users in the design of a system for sharing lessons from adverse incidents in anaesthesia.
In this qualitative study using observation and interviews, 10 anaesthetists from five Departments of Anaesthesia in the North-West region of England were enlisted to participate in the design of an online system to allow the sharing of critical incidents. Respondents perceived that existing schemes had differing and sometimes conflicting aims. Reporting was used for reasons other than simply logging incidents in the interests of promoting patient safety. ⋯ Seven incidents were posted during the 6-month pilot period. The practitioners in our study valued the opportunity to share and discuss educational incidents 'horizontally' within their community of practice. We suggest that large-scale reporting systems either incorporate such a function or allow other systems that permit such sharing to co-exist.
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Multicenter Study
The changing practice of thoracic epidural analgesia in the United Kingdom: 1997-2004.
The clinical governance framework and medico-legal climate in the United Kingdom has changed significantly in the past 7 years. We used a postal questionnaire to survey thoracic epidural practice in the United Kingdom in 1997 and repeated this survey in 2004. ⋯ Of the 2004 respondents, < 1% used the newer, less toxic local anaesthetics, 49% would consider inserting a thoracic epidural in patients receiving clopidogrel, and 34% would consider inserting a thoracic epidural in patients receiving both aspirin and clopidogrel. A central register of thoracic epidural complications would assist in further developing practice.