Risk Watch e-column
January 2006
An update of risk management news, issues and items of interest
Report on Awareness Under General Anesthesia
At its annual meeting in October, the House of Delegates of the American Society of Anesthesiologists (ASA) in October approved the report “Practice Advisory for Intraoperative Awareness and Brain Function Monitoring.” This report represents the most thorough document to date assisting anesthesiologists and hospitals in minimizing the risks of unintended awareness under general anesthesia.
Unintended awareness involves the patient having some recollection of events during his or her surgery, including hearing sounds and feeling sensations or pain. The incidence of intraoperative awareness has been reported in one to two cases per 1,000 surgeries. Though cases of unintended awareness are unusual and sometimes unavoidable, this phenomenon has been highly publicized in recent years.
The report’s authors advise that the preoperative evaluation should include a review of patient records for potential risk factors, an interview with the patient and a determination of risk factors attached to the procedure in question, e.g. cardiac surgery.
If a patient does become conscious during a procedure, the report provides guidelines regarding management during and after the event:
- The decision to administer a benzodiazepine intraoperatively should be made on a case-by-case basis.
- Patients who report recall of intraoperative events should be interviewed informally or formally to obtain details of the event and to discuss possible reasons for its occurrence.
- Use a questionnaire to obtain a detailed account of the patient’s experience.
- Once an episode has been reported, an occurrence report concerning the event should be completed for the purpose of quality management.
- Offer counseling or psychological support to the patient.
To read the full practice advisory, click here.
(Source: ASA)
First-Ever Global Survey on Unmet Needs in Asthma Treatment
Results from the first-ever global quantitative survey on unmet needs in asthma treatment demonstrated significant discrepancies between physician and patient assessments of current asthma treatment plans.
The Global Asthma Physician and Patient (GAPP) Survey, a 16-country research study, was conducted to highlight the global impact of asthma, a disease that is growing in prevalence by approximately 50% every decade. “Ongoing physician-patient communication is essential in treating chronic conditions such as asthma, and the GAPP Survey reveals there is much room to improve this dialogue in every country we studied,” stated G. Walter Canonica MD, University of Genova, Italy, for the World Allergy Organization.
According to the survey:
- Patients who have experienced side effects from medications frequently cite the side effects as a reason for noncompliance with treatment; only 26% of patients report that they are compliant at least half the time.
- Physicians typically overestimate how often their patients comply with treatment regimens.
- In each country surveyed, patients and physicians report dramatically different assessments of how much time is spent on education during office visits: 23% of patients surveyed estimated that during their office visits, no time is spent discussing techniques for successful asthma management; yet, 87% of physicians estimated that up to one-half of office visits with asthma patients is spent on this topic.
(Source: Newswire)
Effective Hospital Patient “Handoffs” Require Better Training for Physicians
A study in the December issue of Academic Medicine, “Lost in Translation: Challenges and Opportunities in Physician-to-Physician Communication During Patient Handoffs,” asks what happens when a hospital patient’s physician goes off duty and another physician assumes responsibility for the patient. The answer: Efficient and safe patient handoff often does not occur because physicians are not adequately trained how to effectively communicate during these transfers.
According to the study’s senior author, Richard M. Frankel PhD, poor communication in medical practice is one of the most common causes of medical errors. Frankel is a professor of medicine at the Indiana University School of Medicine.
Among the study’s findings:
- The safest method of transferring responsibility for a patient is face-to-face, during which the physician who is going off duty talks directly with the physician coming on duty.
- Body language and other crucial factors are lost when the handoff is done over the phone, and a written handoff may be difficult to read.
- Written notes are open to misinterpretation or misplacement.
To read an abstract of the study, click here.
(Source: Medical News Today)
