Johannes Wacker | Chair Patient Safety and Quality Committee (PSQC)
Safe anaesthesia and perioperative care is the core of our professional efforts. Most of our patients are seriously affected by their disease or trauma. First of all, we want to avoid their suffering additional harm that stems from the process of healthcare delivery. Safe care means that patients are free from such additional harm. Thereby, safety constitutes a particular dimension of quality. Consistently, PSQC is dedicated to both patient safety and quality.
Having to deal with compromised safety and quality is a common experience for practising anaesthesiologists across different hospital settings and countries. Honestly: Have you never experienced important information deficits due to a rushed handover of a patient between clinicians? A wrong drug administered to a patient? Can you really follow all the guidelines, rules, and protocols you actually should to provide safe perioperative care? Frankly: I doubt any anaesthesiologist always can, despite all efforts. Like other clinicians, anaesthesiologists often strive to do their best for their patients within the boundaries of their influence, and while trading off competing goals against each other.
Problems related to impaired patient safety are far from being theoretical phantasms. Evidence about healthcare-related patient harm is growing in the scientific literature. This evidence helps to carve out in more detail the nature and the extent of patient harm. Adverse events occur in up to 30% of hospital admissions.1 Such adverse events are associated with higher mortality, and may be preventable in about 50% of cases.2 In Europe, surgical mortality before discharge is as high as 4% on average, and varies considerably between countries.3 The ability of institutions to respond to adverse events is crucial for patient outcomes. ‘Failure to rescue’ patients from adverse events increases mortality.4 Hospital safety climate5 including teamwork and coordination influence failure to rescue. For instance, more care transitions (handovers) during anaesthesia6 and reduced nurse staffing7 are associated with impaired patient outcomes.
The ESA has been committed to promoting patient safety for many years. The Helsinki Declaration on Patient Safety in Anaesthesiology was launched in 2010 and summarises the principal requirements anaesthesia departments should meet in order to deliver safe anaesthesia and perioperative care.8 It has been signed by the ESA and an increasing number of other national anaesthesiology societies (NAS). ESA established the current PSQC in 2014 by merging the former Scientific Subcommittee on Patient Safety and the former Patient Safety Task Force. The PSQC aims at promoting patient safety by education, research, and practical clinical methods.
Since 2009, the European Patient Safety Course has presented an introduction to safety concepts that is organised as a pre-congress course to Euroanaesthesia. A Patient Safety Masterclass was first held during Euroanaesthesia 2014 in Stockholm and is currently being revised to be held as an ESA Masterclass in the coming fall. Details will be announced during Euroanaesthesia 2016. Among others, a particular session during Euroanaesthesia will also highlight the important topic of clinical reasoning and diagnostic errors (Monday, May 30, 2016, 15:45-17:15). According to a recent report of the US Institutes of Medicine,9 diagnostic errors account for 6-17% of adverse events and contribute to about 10% of hospital deaths. Better education, improved teamwork, more support, and adequate time are some of the solutions expected to contribute to improving the sometimes complex and demanding diagnostic process.9
Patient safety and quality can only be improved if it is measured. PSQC has started working on a Patient Safety and Quality Platform designed to share, analyse, and disseminate important insights from national reporting systems on a European level, and in cooperation with NAS. A first project will be dedicated to incident reports. Concurrently, the committee is also working on a comparative overview of Patient Safety and Quality Indicators used in Europe. Furthermore, posters presented at the National Villages during Euroanaesthesia 2016 focus on measurement of patient safety and quality across Europe. Promoting these measurements will complement ongoing human factors-based PSQC activities (e.g., simulation and CRM training, incident reporting, root cause analysis) with a data-based approach to safety and quality improvement. In other words, we will work on bridging the gap between human factors-based patient safety strategies and quantitative perioperative outcomes research.
ESA PSQ Masterclass will be run on November 7-9, 2016 in Madrid
Kennerly DA et al., Health Services Research 2014;49(5):1407-25.
Wacker J, Staender S., Current Opinion in Anaesthesiology 2014;27(6):649-56.
Pearse RM et al., The Lancet. 2012;380(9847):1059-65.
Ghaferi AA et al., Annals of Surgery 2009;250(6):1029-34.
Sheetz KH et al., Annals of Surgery 2016;263(4):692-7.
Hyder JA et al., Anesthesia & Analgesia 2015;120(2):440-8.
Aiken LH et al., Lancet 2014;383(9931):1824-30.
Mellin-Olsen J et al., European Journal of Anaesthesiology 2010;27(7):592-7.
IOM, Improving Diagnosis in Health Care. Washington, DC: The National Acad. Press; 2015.