References: Anesthetic Mishaps; Volume 3 Issue 7

1. AUTHOR	Lienhart-A, Chigot-J-P.
INSTITUTION	Departement d'anesthesie-reanimation, hopital Saint-Antoine, Paris, France.
TITLE	(Claims related to anesthesia at the University Hospitals of Paris). TT Le contentieux en rapport avec l'anesthesie a l'Assistance publique- Hopitaux de Paris.
SOURCE	Ann-Fr-Anesth-Reanim 1996, VOL: 15 (2), P: 215-9, ISSN: 0750-7658.
ABSTRACT	OBJECTIVE: To evaluate the number and the reason of anaesthesia- related malpractice claims in university hospitals of Paris. STUDY DESIGN: Retrospective study. METHODS: From December 1977 to December 1994, 1,185 claims, originating from all departments, dental trauma excluded, were reviewed and classified by one medical expert. They were analyzed with regard to type of activity responsible for the damage. RESULTS: Out of the 789 claims resulting from surgical activity, 41 were directly anaesthesia-related. The most frequent problems were the neurological complications of spinal or epidural anaesthesia (n = 10), and the consequences of difficult intubation or aspiration of stomach contents (n = 5). A series of 19 damages due to posture was difficult to classify as surgery- or anaesthesia-related. In the 41 anaesthesia-related claims, an indemnification was alloted to seven (5.2%). This rate was similar to that for surgical activity- related claims. However, the amount of the anaesthesia-related malpractice compensations was equivalent to 26% of those alloted to the surgery-related claims and to two-thirds of the indemnifications equal to or above 2,000,000 FF. CONCLUSIONS: There are few anaesthesia-related claims in the Paris university hospitals. Only few claims result in a compensation. By contrast, when a indemnification is alloted, its amount is very high. Locoregional anaesthesia seems to be at a higher risk for malpractice claims. Author.

2. AUTHOR	Caplan-R-A, Vistica-M-F, Posner-K-L, Cheney-F-W.
INSTITUTION	Department of Anesthesiology, University of Washington School of Medicine and the Virginia Mason Medical Center, Seattle 98111-0900, USA. ANERA@vmmc.org.
TITLE	Adverse anesthetic outcomes arising from gas delivery equipment: a closed claims analysis (see comments).
SOURCE	Anesthesiology 1997 Oct, VOL: 87 (4), P: 741-8, ISSN: 0003-3022.
CM	Comment in: Anesthesiology 1997 Oct; 87(4):731-3.
ABSTRACT	BACKGROUND: Anesthesia gas delivery equipment is a potentially important source of patient injury. To better define the contribution of gas delivery equipment to professional liability in anesthesia, the authors conducted an in-depth analysis of cases from the database of the American Society of Anesthesiologists Closed Claims Project. METHODS: The database of the Closed Claims Project is composed of closed US malpractice claims that have been collected in a standardized manner. All claims resulting from the use of gas delivery equipment were reviewed for recurrent patterns of injury. RESULTS: Gas delivery equipment was associated with 72 (2%) of 3,791 claims in the database. Death and permanent brain damage accounted for almost all adverse outcomes (n = 55, 76%). Equipment misuse was defined as fault or human error associated with the preparation, maintenance, or deployment of a medical device. Equipment failure was defined as unexpected malfunction of a medical device, despite routine maintenance and previous uneventful use. Misuse of equipment (n = 54, 75%) was three times more common than equipment failure (n = 17, 24%). Misconnects and disconnects of the breathing circuit made the largest contribution to injury (n = 25, 35%). Reviewers judged that 38 of 72 claims (53%) could have been prevented by pulse oximetry, capnography, or a combination of these two monitors. Overall, 56 of 72 gas delivery claims (78%) were deemed preventable with the use or better use of monitors. The year of occurrence for claims involving gas delivery equipment ranged from 1962 to 1991 and did not differ significantly from claims involving other adverse respiratory events. CONCLUSIONS: Claims associated with gas delivery equipment are infrequent but severe and continue to occur in the 1990s. Educational and preventive strategies that focus on equipment misuse and breathing circuit configuration may have the greatest potential for enhancing the safety of anesthesia gas delivery equipment. Author.

3. AUTHOR	Pate-Cornell-M-E, Lakats-L-M, Murphy-D-M, Gaba-D-M.
INSTITUTION	Department of Industrial Engineering and Engineering Management, Stanford University, California 94305, USA. ng.mep@standford.edu.
TITLE	Anesthesia patient risk: a quantitative approach to organizational factors and risk management options.
SOURCE	Risk-Anal 1997 Aug, VOL: 17 (4), P: 511-23, ISSN: 0272-4332.
ABSTRACT	The risk of death or brain damage to anesthesia patients is relatively low, particularly for healthy patients in modern hospitals. When an accident does occur, its cause is usually an error made by the anesthesiologist, either in triggering the accident sequence, or failing to take timely corrective measures. This paper presents a pilot study which explores the feasibility of extending probabilistic risk analysis (PRA) of anesthesia accidents to assess the effects of human and management components on the patient risk. We develop first a classic PRA model for the patient risk per operation. We then link the probabilities of the different accident types to their root causes using a probabilistic analysis of the performance shaping factors. These factors are described here as the "state of the anesthesiologist" characterized both in terms of alertness and competence. We then analyze the effects of different management factors that affect the state of the anesthesiologist and we compute the risk reduction benefits of several risk management policies. Our data sources include the published version of the Australian Incident Monitoring Study as well as expert opinions. We conclude that patient risk could be reduced substantially by closer supervision of residents, the use of anesthesia simulators both in training and for periodic recertification, and regular medical examinations for all anesthesiologists. Author.