British journal of anaesthesia
-
Communication is critical to safe patient care. In this issue of the British Journal of Anaesthesia, Jaulin and colleagues show that use of a Post-Anaesthesia Team Handover (PATH) checklist is associated with fewer hypoxaemia events in the PACU, reduced handover interruptions, and other important metrics related to improved communication. The PATH checklist provides a link within a broader chain of safety checklists and other interventions that comprise a perioperative chain of survival.
-
The results of the PErioperAtive CHildhood ObesitY (PEACHY) study showed an alarmingly high incidence of obesity amongst children presenting for surgical procedures under general anaesthesia in the UK. The study was performed by the Paediatric Anaesthesia Trainee Research Network (PATRN), a network of trainee anaesthetists seeking to quantify important clinical problems. Networks and consortia that facilitate collaboration amongst clinicians and academics working in a wide range of types of hospitals are particularly important in the current era, as they have the potential to gather data rapidly on important clinical problems, and by their size improve the power to identify factors associated with rare complications. Collaboration amongst clinicians within networks instead of competition between clinicians can have wide-ranging benefits that extend beyond research, and can include improvements in training, rapid dissemination of protocols, and knowledge concerning new problems, ultimately improving general standards of care.
-
Editorial Comment
The ethics of quality improvement studies: do the needs of the many outweigh the needs of the few?
Clinical research involving human subjects and quality improvement (QI) projects share a common goal of seeking to improve human health, whether by directly changing the standard of care (research) or by improving the process(es) by which that care is delivered (QI). Whether a QI project requires informed consent (written or oral) is a function of the risk-benefit analysis of the study; such a determination should not be at the sole discretion of the investigators, but should come from an appropriately constituted review board with expertise in the ethics of biomedical research.
-
Terms such as prospective, interventional, and controlled are redundant in the context of randomised trials, and are therefore distracting. Pragmatic should probably be reserved for trials that intentionally control little except the exposure. The term pilot should be reserved for trials that were designated to a priori and registered as pilot trials, and have appropriate pilot outcomes. 'Pragmatic' and 'real-world' should not be inserted to excuse poor trial design; and similarly, 'pilot' should not be appended to excuse inadequate power.
-
Safe delivery of patient care in the operating theatre is complex and co-dependent of many individual, organisational, and environmental factors, including patient, task and technology, individual, and human factors. The Six Sigma approach aims to implement a data-driven strategy to reduce variability and consequently improve safety. Analytical data platforms such as a Black Box ought to be embraced to support process optimisation and ultimately create a higher level of Six Sigma safety performance of the operating theatre team.