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14-03-2012 | Surgery | Article

Anesthesiologists need time out after perioperative catastrophe


Free abstract

MedWire News: US anesthesiologists believe their ability to provide good patient care is compromised in the immediate aftermath of a perioperative catastrophe, yet very few are given time off to recover, show survey results published in Anesthesia and Analgesia.

Most respondents reported feeling guilt and anxiety for at least a week after such events, with almost one in five saying they never made a full emotional recovery.

Researchers led by Farnaz Gazoni (University of Virginia Health System, Charlottesville) sent surveys to 1200 randomly selected members of the American Society of Anesthesiologists, 56% of whom responded. Of these, 84% had been involved in at least one unanticipated perioperative death or serious injury at some point in their careers.

Most respondents felt that unanticipated death, cardiac arrest, myocardial infarction, stroke or other brain injury, visual loss, and wrong site or wrong patient incident qualified as catastrophic perioperative events.

Referring to the "most memorable" perioperative catastrophe in their own experiences, the respondents reported that 67% of incidents involved the death of a patient and 46% occurred during surgery.

Just 54% of respondents were the main anesthesia provider at the time of the incident, and 61% of events were probably or definitely not related to anesthesia. Yet more than 70% of respondents felt guilt and anxiety, and relived the event, and more than 60% feared litigation and were depressed. Just under half suffered professional self-doubt, 12% considered a career change, and 7% resorted to alcohol or drugs.

Three-quarters of the 52% of respondents who felt the catastrophe was preventable felt personally responsible, but so did 64% of those who felt it was not preventable.

The catastrophe had a lasting emotional impact on most respondents. About 10% claimed to be unaffected, but most said they took some time to recover. The most frequent length of recovery time was 1 week, selected by 21% of respondents, but many took longer, with 19% saying they had never fully recovered.

Most (67%) respondents felt their ability to provide anesthesia care was compromised at least partly in the first 4 hours after the catastrophe, 27% felt compromised for a whole week, and 16% said their abilities were compromised for more than a week.

Yet just 7% of respondents were given any time off immediately after the event. Three-quarters felt that time off should be offered, and 9% that it should be required, with most saying that at least the remainder of the day should be given off.

Editorialists Timothy Martin (University of Arkansas for Medical Sciences, Little Rock, USA) and Raymond Roy (Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA) say that, despite the large amount of reporting and review that inevitably follows such a case, "rarely is there a formal wellness advocate for the anesthesiologist who was closely involved with, or perhaps responsible for, the patient at the time of the catastrophe."

They make several recommendations, foremost of which is that institutions should seriously consider relieving anesthesiologists and other involved staff of their duties for at least the rest of the day following a perioperative catastrophe.

"This is often difficult in today's medical economic climate with its attendant high production pressure and demand for rapid turn-over between cases, but the real possibility exists that follow-on patients may be put at increased risk of an adverse outcome themselves," they say.

By Eleanor McDermid

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