British journal of anaesthesia
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Review
Quality, safety, and outcomes in anaesthesia: what's to be done? An international perspective.
This article reviews of some of the key topics and challenges in quality, safety, and the measurement and improvement of outcomes in anaesthesia. The topics were selected based on the perspective of an individual with quality and safety expertise and recent experience of the specialty in both the UK and USA. The review does not seek to be exhaustive or systematic, but to highlight current areas of concern and potential solutions. ⋯ These levels are as follows: the microsystem or patient and individual clinician perspective; the meso or hospital perspective; and the macro or government and policy perspective. Topics covered include medication safety, changes in approaches to patient safety, payment reform, longer term measurement of outcomes, large-scale improvement programmes, the ageing population, and burnout. The article begins with a section on the success of the specialty of anaesthesia in improving the quality, safety, and outcomes for our patients, and ends with a look to future developments, including greater use of technology and patient engagement.
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Approximately 12% of apparently previously cognitively well patients undergoing anaesthesia and noncardiac surgery will develop symptoms of cognitive dysfunction after their procedure. Recent articles in this Journal have highlighted the difficulties of confirming any clear links between anaesthesia and cognitive dysfunction, in part because of the lack of consistency regarding definition and diagnosis. Postoperative cognitive dysfunction (POCD) is usually self-limiting and rarely persists in the longer term, although plausible biological mechanisms for an impact on brain protein deposition do exist. ⋯ As yet no individual anaesthetic technique, drug or mode of monitoring has been proved to reduce the incidence of POCD. Providing patients with appropriate and accurate information can be difficult because of conflicting evidence. The Royal College of Anaesthetists' patient liaison group has produced a useful patient information leaflet that is designed to provide guidance in discussions of individual risks whilst considerable uncertainties remain.
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Comparative Study
Effectiveness of enhanced pulse oximetry sonifications for conveying oxygen saturation ranges: a laboratory comparison of five auditory displays.
Anaesthetists monitor auditory information about a patient's vital signs in an environment that can be noisy and while performing other cognitively demanding tasks. It can be difficult to identify oxygen saturation (SpO2) values using existing pulse oximeter auditory displays (sonifications). ⋯ Enhanced sonifications are more informative than conventional sonification. The implication is that they might allow anaesthetists to judge better when desaturation decreases below, or returns to, a target range.
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Robotic surgery pushes the frontiers of innovation in healthcare technology towards improved clinical outcomes. We discuss the evolution to five generations of robotic surgical platforms including stereotactic, endoscopic, bioinspired, microbots on the millimetre scale, and the future development of autonomous systems. ⋯ The innovative impact of this technology holds the potential to achieve transformative clinical improvements. However, despite over 30 yr of incremental advances it remains formative in its innovative disruption.
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Human beings who work in complex, dynamic, and stressful situations make mistakes. This is as true for anaesthetists as for any other health-care professional, but we face unique challenges in the many roles and responsibilities we have in diverse clinical contexts. ⋯ This review considers the impact of error in health care; the role of anaesthetists in promoting simulation-based education for the development of clinical skills and improved teamwork; and their role in disseminating human factors and quality improvement science to enhance safety in the clinical workplace. Finally, we consider our position at the vanguard of developments in patient safety and how the profession should continue to pursue a leadership role in the application of simulation-based interventions to training and systems design across health care.