Search

Patient safety is a core principle of anesthesia care worldwide. The specialty of anesthesiology has been a leader in medicine for the past half century in pursuing patient safety research and implementing standards of care and systematic improvements in processes of care. Together, these efforts have dramatically reduced patient harm associated with anesthesia. However, improved anesthesia patient safety has not been uniformly obtained worldwide. There are unique differences in patient safety outcomes between countries and regions in the world. These differences are often related to factors such as availability, support, and use of health care resources, trained personnel, patient safety outcome data collection efforts, standards of care, and cultures of safety and teamwork in health care facilities. This article provides insights from national anesthesia society leaders from 13 countries around the world. The countries they represent are diverse geographically and in health care resources. The authors share their countries' current and future initiatives in anesthesia patient safety. Ten major patient safety issues are common to these countries, with several of these focused on the importance of extending initiatives into the full perioperative as well as intraoperative environments. These issues may be used by anesthesia leaders around the globe to direct collaborative efforts to improve the safety of patients undergoing surgery and anesthesia in the coming decade.

Coronavirus Disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers, health systems, and economies. As it reaches low- and middle-income countries, its effects could be even more dire, because it will be difficult for them to respond aggressively to the pandemic. There is a great shortage of all health care providers, who will be at risk due to a lack of personal protection equipment. Social distancing will be almost impossible. The necessary resources to treat patients will be in short supply. The end result could be a catastrophic loss of life. A global effort will be required to support faltering economies and health care systems.

Background Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequences of surgery. Despite being rapidly taken up by practitioners, data points from which to derive the indicators were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define—for the first time—the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care globally. Methods and findings The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a 2-day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. The meeting was held between June 16 to 18, 2019; discussions continued until August 2020. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high-, middle-, and low-income countries. Considering each of the 6 indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2 to 5 (intermediate) and >5 year (full) time frames. We removed one of the original 6 indicators (one of 2 financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. A strength of the process was the number of people from global institutes and multilateral agencies involved in the collection and reporting of global health metrics; a limitation was the limited number of participants from low- or middle-income countries—who only made up 21% of the total attendees. Conclusions To track global progress towards timely access to quality SAO care, these indicators—at the basic level—should be implemented universally as soon as possible. Intermediate and full indicator sets should be achieved by all countries over time. Meanwhile, these evolutions can assist in the short term in developing national surgical plans and collecting more detailed data for research studies., Justine Davies and colleagues discuss the development of updated indicators to support global achievement of access to safe surgical, anaesthetic, and obstetric care.

Norwegian anaesthesiologists use a pulse oximeter for each and every case in the operating theatre. However, we suspected that most rely on the visual scale and alarm only (routinely set at 90% at our institution), and that the variable pitch sound of the pulse oximeter is not routinely audible during anaesthesia. In order to verify this, a short survey (3 questions) was emailed to all registered anaesthesiologists (specialists and trainees) in Norway during September 2020. The sample was based on the Norwegian Society of Anaesthesiology membership register, which includes both clinically active and non-active members.

Article 25 of the United Nations' Universal Declaration of Human Rights enshrines the right to health and well-being for every individual. However, universal access to high-quality healthcare remains the purview of a handful of wealthy nations. This is no more apparent than in peri-operative care, where an estimated five billion individuals lack access to safe, affordable and timely surgical care. Delivery of surgery and anaesthesia in low-resource environments presents unique challenges that, when unaddressed, result in limited access to low-quality care. Current peri-operative research and clinical guidance often fail to acknowledge these system-level deficits and therefore have limited applicability in low-resource settings. In this manuscript, the authors priority-set the need for equitable access to high-quality peri-operative care and analyse the system-level contributors to excess peri-operative mortality rates, a key marker of quality of care. To provide examples of how research and investment may close the equity gap, a modified Delphi method was adopted to curate and appraise interventions which may, with subsequent research and evaluation, begin to address the barriers to high-quality peri-operative care in low- and middle-income countries.

Counting health personnel and defining migration is more complicated than one should think at first glance. Migrating health workers are not a homogenous group, and many factors cause people to migrate - not only low wages, but also lack of professional development possibilities, poor job satisfaction, outdated equipment, unsafe environment and more. The opposite factors encourage people to stay. Many countries, including high income countries benefit from remittances from migrating individuals. The World Health Organization has installed a code of Practice on the international recruitment of health workers. Although member countries have committed to follow this Code, it is not widely adhered to. Planning for the future is difficult, also because there are so many unknown factors related to the development of health care levels, policies, inflow and outflow and more. Action must be taken in both donor and receiving countries. In anaesthesiology, there is a huge workforce deficit globally. The world would need 136,000 additional physician anaesthesia providers today in order to achieve an absolute minimum of five per 100,000 population. This will not happen unless all countries follow those that already have taken proactive steps in leading the direction forward. Anaesthesiology Society involvement is crucial.

Purpose of review Four years after the launch of the Helsinki Declaration on Patient Safety in Anaesthesiology, it is of interest to assess its role in European and Global Patient Safety efforts. Recent findings The Declaration is widely supported, not only in Europe, but also has attracted much attention and support globally. In Europe, it represented a major step in European-wide patient safety networking and initiatives. The European Patient Safety Task Force, created jointly by the European Board of Anaesthesiology and the European Society of Anaesthesiology, has developed useful monitoring and introduction tools. A new Patient Safety Committee is being introduced, and this will facilitate current and future initiatives. Summary The launch of Helsinki Declaration of Patient Safety in Anaesthesiology in 2010 was a major step forward for patient safety initiatives in European and Global anesthesiology. Several steps have been taken in the 4 years that have passed, but the task needs continuous attention to ensure that every patient received the safest possible anesthesiology care.

These European Board of Anaesthesiology (EBA) recommendations for safe medication practice replace the first edition of the EBA recommendations published in 2011. They were updated because evidence from critical incident reporting systems continues to show that medication errors remain a major safety issue in anaesthesia, intensive care, emergency medicine and pain medicine, and there is an ongoing need for relevant up-to-date clinical guidance for practising anaesthesiologists. The recommendations are based on evidence wherever possible, with a focus on patient safety, and are primarily aimed at anaesthesiologists practising in Europe, although many will be applicable elsewhere. They emphasise the importance of correct labelling practice and the value of incident reporting so that lessons can be learned, risks reduced and a safety culture developed.

Background: The Board of the Scandinavian Society for Anaesthesiology and Intensive Care Medicine (SSAI) decided in 2008 to undertake a survey among members of the SSAI aiming at exploring some key points of training, professional activities and definitions of the specialty. Methods: A web-based questionnaire was used to capture core data on workforce demographics and working patterns together with opinions on definitions for practice/practitioners in the four areas of anaesthesia, intensive care medicine, emergency medicine and pain medicine. Results: One thousand seven hundred and four responses were lodged, representing close to half of the total SSAI membership. The majority of participants reported in excess of 10 years of professional experience in general anaesthesia and intensive care medicine as well as emergency and pain medicine. While no support for separate or secondary specialities in the four areas was reported, a majority of respondents favoured sub-specialisation or recognition of particular medical competencies, notably so for intensive care medicine. Seventy-five percent or more of the respondents supported a common framework of employment within all four areas irrespective of further specialisation. Conclusions: The future of Scandinavian anaesthesiology is likely to involve further specialisation towards particular medical competencies. With such diversification of the workforce, the majority of the respondents still acknowledge the importance of belonging to one organisational body.

Traditionally, Scandinavian anaesthesiologists have had a very broad scope of practice, involving intensive care, pain and emergency medicine. European changes in the different medical fields and the constant reorganising of health care may alter this. Therefore, the Board of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) decided to produce a Position Paper on the future of the speciality in Scandinavia. The training in the various Scandinavian countries is very similar and provides a stable foundation for the speciality. The Scandinavian practice in anaesthesia and intensive care is based on a team model where the anaesthesiologists work together with highly educated nurses and should remain like this. However, SSAI thinks that the role of the anaesthesiologists as perioperative physicians is not fully developed. There is an obvious need and desire for further training of specialists. The SSAI advanced educational programmes for specialists should be expanded and include formal assessment leading to a particular medical competency as defined by the European Union of Medical Specialists (UEMS). In this way, Scandinavian anaesthesiologists will remain leaders in perioperative, intensive care, pain and critical emergency medicine.

Anaesthesiology, which includes anaesthesia, perioperative care, intensive care medicine, pain therapy and emergency medicine, has always participated in systematic attempts to improve patient safety. Anaesthesiologists have a unique, cross-specialty opportunity to influence the safety and quality of patient care. Past achievements have allowed our specialty a perception that it has become safe, but there should be no room for complacency when there is more to be done. Increasingly older and sicker patients, more complex surgical interventions, more pressure on throughput, new drugs and devices and simple chance all pose hazards in the work of anaesthesiologists. In response to this increasingly difficult and complex working environment, the European Board of Anaesthesiology (EBA), in cooperation with the European Society of Anaesthesiology (ESA), has produced a blueprint for patient safety in anaesthesiology. This document, to be known as the Helsinki Declaration on Patient Safety in Anaesthesiology, was endorsed by these two bodies together with the World Health Organization (WHO), the World Federation of Societies of Anaesthesiologists (WFSA), and the European Patients' Federation (EPF) at the Euroanaesthesia meeting in Helsinki in June 2010. The Declaration represents a shared European view of that which is worthy, achievable, and needed to improve patient safety in anaesthesiology in 2010. The Declaration recommends practical steps that all anaesthesiologists who are not already using them can successfully include in their own clinical practice. In parallel, EBA and ESA have launched a joint patient safety task-force in order to put these recommendations into practice. It is planned to review this Declaration document regularly.

The aim of the European Union of Medical Specialists is to improve and harmonise training and free movement of medical specialists in Europe. The training of European anaesthesiologists varies across country borders. The Section and Board of Anaesthesiology has chaired the development of new training guidelines and curriculum which will serve to make the training more uniform. We have also been pioneers in patient safety and in developing our specialty with its various areas of competence. We need to take charge of our own future, also when it comes to manpower and medical development.

In the last decade, competency-based curricula in anaesthesiology, resuscitation and intensive care have been slowly implemented in Europe, based mainly on the Canadian Medical Education Directions for Specialists (CanMEDS) framework for doctor competencies, which requires that a competent doctor should be proficient in seven distinct roles. This framework is an outcomebased education model spanning a large range of domains of activities and associated competencies to be acquired. Learning outcomes have been defined that underpin these competencies and should permit appropriate trainee evaluation and assessment.