British journal of anaesthesia
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Review
Non-technical skills of anaesthetic assistants in the perioperative period: a literature review.
Non-technical skills (NTS), which include communication, teamwork, leadership, decision-making, and situation awareness, are important in the maintenance of patient safety. NTS frameworks have been developed for anaesthetists, surgeons, and scrub practitioners. Most studies of NTS in operating theatres to date have focused on anaesthetists and surgeons. ⋯ Communication and situation awareness were described in three papers, teamwork and decision-making in two, and leadership in one. This search did not reveal any comprehensive description of the NTS required by anaesthetic assistants. The benefits of developing an NTS taxonomy for anaesthetic assistants are discussed.
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Summary This article discusses how to estimate the risk of postoperative death, an outcome that affects an important minority of patients in the month(s) after scheduled surgery. In addition, it reflects on our inability to characterize the effects of surgery on quality of life. This outcome is of primary concern to the much more numerous survivors but is absent from all graphs of postoperative survival: it is the missing axis. The calculations discussed in the article are available online at https://sites.google.com/site/informrisk/.
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After recent UK policy developments, considerable attention has been focused upon how clinical specialties measure and report on the quality of care delivered to patients. Defining the right indicators alone is insufficient to close the feedback loop. This narrative review aims to describe and synthesize a diverse body of research relevant to the question of how information from quality indicators can be fed back and used effectively to improve care. ⋯ The dominant model for use of data within quality improvement is based upon the industrial process control approach, in which care processes are monitored continuously for process changes which are rapidly detectable for corrective action. From this review and experience of implementing these principles in practice, effective feedback from quality indicators is timely, credible, confidential, tailored to the recipient, and continuous. Considerable further work is needed to understand how information from quality indicators can be fed back in an effective way to clinicians and clinical units, in order to support revalidation and continuous improvement.
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Summary In law, consent allows the patient to determine what treatments they will accept or refuse. In this article, the common law of consent relating to anaesthesia is reviewed in order to highlight more recent changes to the standard of information provision and treatment of patients without capacity, and to form the basis of a critique of the current law. Practical and conceptual problems with the three core pillars of consent-voluntariness, capacity, and information-are analysed, along with the identification of logistical problems and contemporary theoretical challenges to the notion of patient autonomy as the basis of consent, concluding that 'assent' better describes the current legal position regarding treatment permission than 'consent'. In spite of this, the process of consent/assent is recognized as a major incentive towards data collection about patient-, operator-, and institution-specific risk, in order to better inform patients about the risks and benefits of treatment.