British journal of anaesthesia
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Review
Morbidity, mortality, and systems safety in non-operating room anaesthesia: a narrative review.
Non-operating room anaesthesia (NORA) describes anaesthesia delivered outside a traditional operating room (OR) setting. Non-operating room anaesthesia cases have increased significantly in the last 20 yr and are projected to account for half of all anaesthetics delivered in the next decade. In contrast to most other medication administration contexts, NORA is performed in high-volume fast-paced environments not optimised for anaesthesia care. ⋯ Despite relatively few attempts to quantify safety concerns, it was possible to find a range of systems safety concerns repeated across multiple studies, including insufficient lighting, noise, cramped workspace, and restricted access to patients. Old and unfamiliar equipment, lack of team familiarity, and limited preoperative evaluation are also commonly noted challenges. Applying a systems view of safety, it is possible to suggest a range of methods to improve NORA safety and performance.
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Specialist training bodies continue to devise innovative methods of gathering information on trainee workplace performance to meet the requirements of competency-based medical education. We reviewed recent innovations in workplace-based assessment (WBA) tools to identify strengths, weaknesses, and trade-offs inherent in their design and use. ⋯ Our synthesis of the literature on innovative WBAs provides a framework for categorising tool characteristics across seven dimensions, systematically teasing apart the considerations in design and use of workplace assessments. It also draws attention to the trade-offs inherent in tool design and selection, and enables a more deliberate consideration of the tool characteristics most appropriate to the local context.
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Specialist training bodies continue to devise innovative methods of gathering information on trainee workplace performance to meet the requirements of competency-based medical education. We reviewed recent innovations in workplace-based assessment (WBA) tools to identify strengths, weaknesses, and trade-offs inherent in their design and use. ⋯ Our synthesis of the literature on innovative WBAs provides a framework for categorising tool characteristics across seven dimensions, systematically teasing apart the considerations in design and use of workplace assessments. It also draws attention to the trade-offs inherent in tool design and selection, and enables a more deliberate consideration of the tool characteristics most appropriate to the local context.
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We systematically reviewed published outcome measures across randomised controlled trials (RCTs) of donor management interventions. ⋯ The majority of RCTs evaluating donor management interventions only assessed single-organ outcomes or effects on donor stability in critical care. There is a need for an evaluation of patient-centred recipient outcomes and standardisation and reporting of outcome measures for future donor management RCTs.
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We systematically reviewed published outcome measures across randomised controlled trials (RCTs) of donor management interventions. ⋯ The majority of RCTs evaluating donor management interventions only assessed single-organ outcomes or effects on donor stability in critical care. There is a need for an evaluation of patient-centred recipient outcomes and standardisation and reporting of outcome measures for future donor management RCTs.