According to the NewScientists, anaesthesia wears off in about 0.02% of surgeries worldwide. In 2008, a study conducted by Washington University School of Medicine in St. Louis found that around 30,000 Americans a year awaken during surgical procedures, more often in children, sometimes experiencing intense pain and terror.
Researchers at the Massachusetts Institute of Technology (MIT) led by Emery Brown used an EEG cap with 64 electrodes to keep track of patients' brain activity across multiple brain regions as unconsciousness was induced using general anaesthetic. The team identified patterns related to consciousness and unconsciousness, and were thereby able to determine when a patient was waking up.
In the UK, about 2 % of hospitals do EEG monitoring during surgery, but only 3 or 4 electrodes are used. It only monitors one region of the brain, but the MIT team’s 64-electrode cap could bring new insight into patients’ levels of awareness during surgery, although it requires patients to shave their heads and EEG measurements are very sensitive to mechanical and electrical interference. The technique is not yet available in clinical settings.
Source: Consciousness signature warns of awareness during surgery. New Scientists, March 2013
Fewer patients awake during surgery
A new report published by the Royal College of Anaesthetists found that 153 cases of accidental awareness reported in 2011 across the UK, about 1 in every 15,000 general anaesthetics, a lot less than had been thought. Previous study found that about 1 in 500 patients were aware or awake under general anaesthetics. However, the leader of the new report, Professor Jaideep Pandit, says that under-reporting is possible partly because anaesthetists do not routinely see patients after an operation, so may not be aware of the awareness report. Sometimes patients do not report the incident.
Pandit says brain monitoring systems are available in about two-thirds of UK hospitals, but most anesthesiologists do not use them and there is a debate over how useful the monitors are. He is planning more research to focus on patient experience.
Source: Pandit JJ, Cook TM, Jonker WR, et al. A national survey of anaesthetists (NAP5 Baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK. British Journal of Anaesthesia. Published online March 13 2013
Tuesday, March 19, 2013
Monday, March 18, 2013
Patient safety strategies - a call for physician leadership
According to the editorial articles in the March issue of the Annals of Internal Medicine , tens of thousands of patients die each year in the US of diagnostic errors, teamwork and communiction errors and failure to receive evidence-based interventions.
A team of experts re-examined 158 patient safety topics and elected 41 for reviews that foucus on emerging data about implementing the strategies. The results have been published in the Agency for Healthcare Research and Quality (AHRQ) report, "Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices
. Annals of Internal Medicine, 5 March 2013, Vol. 158. No. 5_Part_1
The data show that checklists and bundles, that many physicians have been unwilling to consider, can substantially improve patient safety and quality of care. It is important that physicians identify the steps that they will take in the diagnosis and care of the most common clincial problems they confront and follow the protocols with appropriate individual variation.
The report emphasizes the importance that physicians understand the team function and lead by example, hand hydiene is an example of the importance of physician behaviour in reducing hospital-aquired infections.
The reviewers wrote, "Making patients safe requires ongoing efforts to improve practices, training, information technology and culture. It requires that senior leaders supply resources and leadership while simultaneously promoting engagement and innovation by frontline clinicians" .
They recommended 10 patient safety strategies for immediate implementation.
Preoperative and anesthesia checklists
Bundles
that include checklists to prevent central line-associated bloodstream infections
Interventions to reduce urinary catheter use
Bundles of various strategies to prevent ventilator-associated pneumonia
Hand hygiene
The do-not-use list for hazardous abbreviations
Interventions to reduce pressure ulcers
Barrier precautions to prevent infections
Use of real-time ultrasonography for central line placement
Interventions to improve prophylaxis for venous thromboembolisms.
Other recommendations include developing interventions that focus on fall prevention, limiting adverse drug reactions, medication reconciliation, reducing radiation exposure from unnecessary medical procedures and developing better informed consent policies.
To read the free f/t articles :Editorial
Making Health Care Safer: A Critical Review of Evidence Supporting Strategies to Improve Patient Safety
A team of experts re-examined 158 patient safety topics and elected 41 for reviews that foucus on emerging data about implementing the strategies. The results have been published in the Agency for Healthcare Research and Quality (AHRQ) report, "Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices
. Annals of Internal Medicine, 5 March 2013, Vol. 158. No. 5_Part_1
The data show that checklists and bundles, that many physicians have been unwilling to consider, can substantially improve patient safety and quality of care. It is important that physicians identify the steps that they will take in the diagnosis and care of the most common clincial problems they confront and follow the protocols with appropriate individual variation.
The report emphasizes the importance that physicians understand the team function and lead by example, hand hydiene is an example of the importance of physician behaviour in reducing hospital-aquired infections.
The reviewers wrote, "Making patients safe requires ongoing efforts to improve practices, training, information technology and culture. It requires that senior leaders supply resources and leadership while simultaneously promoting engagement and innovation by frontline clinicians" .
They recommended 10 patient safety strategies for immediate implementation.
To read the free f/t articles :Editorial
- Strategies to improve patient safety: the evidence base matures
- Patient safety strategies: a call for physician leadership
Patient satisfaction - BMJ article
The patient satisfaction chasm: the gap between hospital management and frontline clinicians
BMJ Quality & Safty 2013;22:3 242-250 Published Online First: 23 November 2012 (f/t via Athens)
Abstract
Background Achieving high levels of patient satisfaction requires hospital management to be proactive in patient-centred care improvement initiatives and to engage frontline clinicians in this process.
Method We developed a survey to assess the attitudes of clinicians towards hospital management activities with respect to improving patient satisfaction and surveyed clinicians in four academic hospitals located in Denmark, Israel, the UK and the USA.
Results We collected 1004 questionnaires (79.9% response rate) from four hospitals in four countries on three continents. Overall, 90.4% of clinicians believed that improving patient satisfaction during hospitalisation was achievable, but only 9.2% of clinicians thought their department had a structured plan to do so, with significant differences between the countries. Among responders, only 38% remembered targeted actions to improve patient satisfaction and just 34% stated having received feedback from hospital management regarding patient satisfaction status in their department during the past year. In multivariate analyses, clinicians who received feedback from hospital management and remembered targeted actions to improve patient satisfaction were more likely to state that their department had a structured plan to improve patient satisfaction.
Conclusions This portrait of clinicians’ attitudes highlights a chasm between hospital management and frontline clinicians with respect to improving patient satisfaction. It appears that while hospital management asserts that patient-centred care is important and invests in patient satisfaction and patient experience surveys, our findings suggest that the majority do not have a structured plan for promoting improvement of patient satisfaction and engaging clinicians in the process.
BMJ Quality & Safty 2013;22:3 242-250 Published Online First: 23 November 2012 (f/t via Athens)
Abstract
Background Achieving high levels of patient satisfaction requires hospital management to be proactive in patient-centred care improvement initiatives and to engage frontline clinicians in this process.
Method We developed a survey to assess the attitudes of clinicians towards hospital management activities with respect to improving patient satisfaction and surveyed clinicians in four academic hospitals located in Denmark, Israel, the UK and the USA.
Results We collected 1004 questionnaires (79.9% response rate) from four hospitals in four countries on three continents. Overall, 90.4% of clinicians believed that improving patient satisfaction during hospitalisation was achievable, but only 9.2% of clinicians thought their department had a structured plan to do so, with significant differences between the countries. Among responders, only 38% remembered targeted actions to improve patient satisfaction and just 34% stated having received feedback from hospital management regarding patient satisfaction status in their department during the past year. In multivariate analyses, clinicians who received feedback from hospital management and remembered targeted actions to improve patient satisfaction were more likely to state that their department had a structured plan to improve patient satisfaction.
Conclusions This portrait of clinicians’ attitudes highlights a chasm between hospital management and frontline clinicians with respect to improving patient satisfaction. It appears that while hospital management asserts that patient-centred care is important and invests in patient satisfaction and patient experience surveys, our findings suggest that the majority do not have a structured plan for promoting improvement of patient satisfaction and engaging clinicians in the process.
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