British journal of anaesthesia
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Simulation is an accepted part of training, assessment, and research in aviation, nuclear power, and the military. Confidence in results in these industries is underpinned by relatively comprehensive and widely accepted standards. ⋯ The absence of standards undermines confidence in the results of any simulation-based endeavour and increases the risk of negative learning. We propose a practical framework for setting standards for simulators for anaesthesia.
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Unreliable delivery of best practice care is a major component of medical error. Critically ill patients are particularly susceptible to error and unreliable care. Human factors analysis, widely used in industry, provides insights into how interactions between organizations, tasks, and the individual worker impact on human behaviour and affect systems reliability. ⋯ Technical interventions should be embedded in everyday practice by the adjunctive use of non-technical (behavioural) interventions. These include executive 'adoption' of clinical areas, systematic methods for identifying hazards and reflective learning from error, and a range of techniques for improving teamworking and communication. Human factors analysis provides a useful framework for understanding and rectifying the causes of error and unreliability, particularly in complex systems such as critical care.
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The person-centred analysis and prevention approach has long dominated proposals to improve patient safety in healthcare. In this approach, the focus is on the individual responsible for making an error. An alternative is the systems-centred approach, in which attention is paid to the organizational factors that create precursors for individual errors. ⋯ Since the factors that promote errors are not directly visible in the working environment, they are described as latent risk factors (LRFs). Safety failures in anaesthesia, in particular, and medicine, in general, result from multiple unfavourable LRFs, so we propose that effective interventions require that attention is paid to interactions between multiple factors and actors. Understanding how LRFs affect safety can enable us to design more effective control measures that will impact significantly on both individual performance and patient outcomes.
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Anaesthetists in the Defence Medical Services spend most of their clinical time in the National Health Service and deploy on military operations every 6-18 months. The deployed operational environment has a number of key differences particularly as there is more severe trauma than an average UK hospital and injury patterns are mainly due to blast or ballistics. Equipment may also be unfamiliar and there is an expectation to be conversant with specific standard operating procedures. ⋯ This includes current work in the field hospital in Afghanistan and also preparing to work for the Royal Air Force and Royal Navy. We highlight the importance of human factors with reference to the type of case mix seen in the field hospital. We also detail the current pre-deployment training package, which employs multiple educational tools including high-fidelity simulation.