Critical incident monitoring in anaesthesia

Yin Choy Choy

    Research output: Contribution to journalArticle

    8 Citations (Scopus)

    Abstract

    Critical incident monitoring in anaesthesia is an important tool for quality improvement and maintenance of high safety standards in anaesthetic services. It is now widely accepted as a useful quality improvement technique for reducing morbidity and mortality in anaesthesia and has become part of the many quality assurance programmes of many general hospitals under the Ministry of Health. Despite wide-spread reservations about its value, critical incident monitoring is a classical qualitative research technique which is particularly useful where problems are complex, contextual and influenced by the interaction of physical, psychological and social factors. Thus, it is well suited to be used in probing the complex factors behind human error and system failure. Human error has significant contributions to morbidities and mortalities in anaesthesia. Understanding the relationships between, errors, incidents and accidents is important for prevention and risk management to reduce harm to patients. Cardiac arrests in the operating theatre (OT) and prolonged stay in recovery, constituted the bulk of reported incidents. Cardiac arrests in OT resulted in significant mortality and involved mostly de-compensated patients and those with unstable cardiovascular functions, presenting for emergency operations. Prolonged-stay in the recovery room was for various reasons: warming up, stabilizing cardiovascular functions with fluid resuscitation and extended period of observation for ill patients. Prolonged stay in recovery was justifiable in some cases, as these patients needed a longer period of post-operative observation until they were stable enough to return to the ward. The advantages of the relatively low cost, and the ability to provide a comprehensive body of detailed qualitative information, which can be used to develop strategies to prevent and manage existing problems and to plan further initiatives for patient safety makes critical incident monitoring a valuable tool in ensuring patient safety. The contribution of critical incident reporting to the issue of patient safety is far from clear and very difficult to study. Efforts to do so have tended to rely on incident reporting, the only practical approach when funding is limited. The heterogeneity of critically ill patients as a group means that huge study populations would be required if other research techniques were to be used. In the era of evidence-based medicine, anaesthetists are looking for alternative evidence-based solutions to problems that we have accepted traditionally when we cannot quantify for good practical reasons. In the quest for patient safety, investment should be made in reliable audit, detection and reporting systems. The growing recognition that human error usually result from a failure of a system rather than an individual should be fostered to allow more lessons to be learnt, an approach that has been successful in other, safety-critical industries. New technology has a great deal to offer and investment is warranted in novel fail-safe drug administration systems. Last but not the least the importance of simple and sensible changes and better education should be remembered.

    Original languageEnglish
    Pages (from-to)577-585
    Number of pages9
    JournalMedical Journal of Malaysia
    Volume61
    Issue number5
    Publication statusPublished - Dec 2006

    Fingerprint

    Patient Safety
    Risk Management
    Anesthesia
    Quality Improvement
    Heart Arrest
    Mortality
    Research Design
    Observation
    Patient Harm
    Morbidity
    Recovery Room
    Safety
    Aptitude
    Qualitative Research
    Evidence-Based Medicine
    Critical Illness
    Resuscitation
    General Hospitals
    Accidents
    Anesthetics

    Keywords

    • Anaesthetic morbidity
    • Critical incident reporting
    • Human error
    • Patients' safety

    ASJC Scopus subject areas

    • Medicine(all)

    Cite this

    Critical incident monitoring in anaesthesia. / Choy, Yin Choy.

    In: Medical Journal of Malaysia, Vol. 61, No. 5, 12.2006, p. 577-585.

    Research output: Contribution to journalArticle

    Choy, YC 2006, 'Critical incident monitoring in anaesthesia', Medical Journal of Malaysia, vol. 61, no. 5, pp. 577-585.
    Choy, Yin Choy. / Critical incident monitoring in anaesthesia. In: Medical Journal of Malaysia. 2006 ; Vol. 61, No. 5. pp. 577-585.
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