Advertisement

Surgical Catastrophes and Anesthesiology

Most anesthesiologists will experience at least one perioperative catastrophe over the course of their careers. These events may have a profound and lasting emotional impact on anesthesiologists and may affect their ability to provide patient care in the aftermath of the incident (see article from guest blogger, Skeptical Scalpel, Complications & Collateral Damage). In an effort to more closely examine the impact of perioperative catastrophes on anesthesiologists, my colleagues and I conducted a survey that was published in Anesthesia & Analgesia. We sent a questionnaire to 1,200 randomly selected members of the American Society of Anesthesiologists who were practicing in the United States. Among the 659 anesthesiologists who completed the survey, 84% had been involved in at least one unanticipated death or serious injury of a perioperative patient during their career. Catastrophic Events Have a Lasting Impact When we asked anesthesiologists to recall their most memorable catastrophic event, more than 70% reported that they experienced guilt and anxiety and reliving the event. Most felt personally responsible for the death or injury, even if they considered the event to be unpreventable. The vast majority (88%) required time to recover emotionally from the catastrophe, and 19% acknowledged having never fully recovered. Another 12% even considered changing careers in the aftermath of the catastrophe. In addition, about two-thirds of the anesthesiologists reported feeling that their ability to care for patients was compromised in the first 4 hours after the event. However, nearly all respondents reported that they carried on with their usual work schedule after the incident occurred. In fact, only 7% were given time off. Our results clearly demonstrate that surgical...

Lessons Learned From Wrong-Site, Wrong-Patient Surgery

Interventions involving a wrong site, wrong patient, or wrong procedure represent an unacceptable surgical complication. Although relatively rare, the results can be catastrophic for patients and physicians alike when wrong-site, wrong-patient surgeries occur. Several national organizations have released recommendations for hospitals and healthcare organizations to develop guidelines that ensure correct-patient, correct-site, and correct-procedure surgery. In 2004, the Joint Commission introduced a Universal Protocol for all accredited hospitals, ambulatory care facilities, and office-based surgical facilities. It consists of three distinct parts: 1) a pre-procedure verification, 2) a surgical-site marking, and 3) a “time-out” performed immediately before the surgical procedure. “Despite the widespread implementation of the Universal Protocol in recent years, wrong-site surgery continues to pose a significant challenge to patient safety,” says Philip F. Stahel, MD, FACS. “We lack reliable data about the true incidence of wrong-patient and wrong-site operations largely because these confidential data may represent just the tip of the iceberg of the most severe occurrences.” In previously published studies, investigators have found that only about one-third of all wrong-site surgery cases result in legal action. It has also been estimated that the Joint Commission event database accounts for just 2% of all wrong-site procedures occurring in the United States. A Common Problem Despite Improvement Efforts In the October 2010 Archives of Surgery, Dr. Stahel and colleagues published an analysis of a prospective physician insurance database in Colorado, which contained more than 27,000 physician self-reported adverse occurrences between January 2002 and June 2008. Over the 6.5-year period, physicians reported 25 wrong-patient and 107 wrong-site procedures to a liability insurance database (Table 1). “Wrong-site, wrong-patient procedures are happening more often...
[ HIDE/SHOW ]