PubMed · 2774163
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B Duffy, M Chittleborough. 1989. Avoiding needle-stick injuries.. https://pubmed.ncbi.nlm.nih.gov/2774163/
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AIMS: To describe and evaluate a simulation based course that emphasizes the role of teamwork in the management of both crises and errors. METHODS: The course allowed participants to experience and manage simulated crises. Emphasis was placed on important error management strategies such as communication, leadership and delegation of workload. A computerized mannequin that is physiologically and pharmacologically responsive was used to run life-like crisis scenarios. The scenarios were videotaped and reviewed during a debriefing discussion after each crisis. Scenarios were alternated with tutorials that addressed error management, communication and medico-legal issues. Participants evaluated the courses using 5-point Likert scales and free comments. RESULTS: In 1999 and 2000, 172 participants (34% of New Zealand anaesthetists) attended one of these courses. Evaluation forms were received from 151 participants (88%). The global evaluations had median scores of 4 or 5 and all respondents would recommend the course to others. The responses from 50 participants indicated that the course should be repeated at least every two years. CONCLUSION: New Zealand anaesthetists found this an acceptable and useful form of training. Teamwork is an effective strategy in crisis management and error reduction and is worthy of consideration within the broader context of medical education.
Scoring systems which try to quantify patient risk are becoming increasingly popular. They have been widely used in intensive care unit patients, trauma patients, and patients undergoing operation. Both general scores, such as APACHE and POSSUM, and specific scores, such as the Detsky Index for post-operative cardiac morbidity and mortality, have been defined. They can be used for comparative audit, to define treatment options, to predict long- and short-term outcome, and to define morbidity and mortality associated with a specific condition. Little evidence yet exists that it is possible to move patients from higher to lower risk groups and thus lower post-operative mortality. However, this may be achieved in time. All surgeons need to be involved in further refinements of scoring systems.
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