Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2011
ReviewEffective handover communication: an overview of research and improvement efforts.
In the recent patient safety literature, there is an increasing agreement that effective patient handover is critical to patient safety by ensuring appropriate coordination among health-care providers and continuity of care. It has repeatedly been pointed out that a lack of formal training and formal systems for patient handover impede the good practice necessary to maintain high standards of clinical care. ⋯ In reviewing the current state of research and improvement, we identified key areas for future research. Despite the growing evidence at the descriptive level, future research will have to take a more systematic approach to establish valid measures of handover quality and safety, establish the causal effects of handover characteristics on safe care and identify best practices in safe handover and effective interventions within and across health-care settings.
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Based on results recorded of perioperative mortality, anaesthetic care is often cited as a model for its improvements with regard to patient safety. However, anaesthesia-related morbidity represents a major burden for patients as yet in spite of major progresses in this field since the early 1980s. More than 1 out of 10 patients will have an intraoperative incident and 1 out of 1000 will have an injury such as a dental damage, an accidental dural perforation, a peripheral nerve damage or major pain. ⋯ To minimise the impact of human errors, guidelines and standardised procedures should be widely implemented. Deficient teamwork and communication should be addressed through specific programmes that have been demonstrated to be effective in the aviation industry: crew resource management (CRM) and simulation. The impact of the overall safety culture of health-care organisations on anaesthesia should not be minimised, and organisational issues should be systematically addressed.
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Best Pract Res Clin Anaesthesiol · Jun 2011
ReviewNon-technical skills for anaesthetists: developing and applying ANTS.
This article examines the non-technical skills approach to enhancing operational safety, with particular reference to anaesthesia. Training and assessing the non-technical skills of staff in safety-critical occupations is accepted by high-risk industries, most notably aviation, but has only recently been adopted in health care. ⋯ This was the first non-technical skills framework specifically designed for anaesthetists, and the authors explain how ANTS was designed as well as its use for selection, training and assessment. Finally, the article mentions similar tools available for surgeons (NOTSS) and scrub nurses (SPLINTS), as well as research activities to develop behavioural rating systems for obstetric anaesthetists and anaesthetic assistants.
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Best Pract Res Clin Anaesthesiol · Jun 2011
ReviewSafety culture in anaesthesiology: basic concepts and practical application.
This article starts from a social science viewpoint and reviews the concepts and measurement of safety culture and climate in their original industrial settings and in health care. Typical items measured and generic characteristics of a positive safety culture are described. The role of personality, professional group membership and anaesthesiology-specific knowledge and expertise in shaping notions of risk and safety and safety behaviour are discussed. The difficulties of changing human behaviour are outlined, and the pivotal role which anaesthesiologists can play in promoting a positive safety culture, both individually and within their teams and organisations, is highlighted.