CRISIS MANAGEMENT

Crises in clinical care: an approach to management

W B Runciman¹ and A F Merry²

¹ Department of Anaesthesia & Intensive Care, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
² Department of Anaesthesiology, University of Auckland, Auckland, New Zealand

Correspondence to:
Correspondence to:
Professor W B Runciman
Australian Patient Safety Foundation, GPO Box 400, Adelaide, South Australia 5001, Australia; research{at}apsf.net.au

A "crisis" in health care is "the point in the course of a disease at which a decisive change occurs, leading either to recovery or to death". The daunting challenges faced by clinicians when confronted with a crisis are illustrated by a tragic case in which a teenage boy died after a minor surgical procedure. Crises are challenging for reasons which include: presentation with non-specific signs or symptoms, interaction of complex factors, progressive evolution, new situations, "revenge effects", inadequate assistance, and time constraints. In crises, clinicians often experience anxiety- and overload-induced performance degradation, tend to use "frequency gambling", run out of "rules" and have to work from first principles, and are prone to "confirmation bias". The effective management of crises requires formal training, usually simulator-based, and ideally in the inter-professional groups who will need to function as a team. "COVER ABCD–A SWIFT CHECK" is a precompiled algorithm which can be applied quickly and effectively to facilitate a systematic and effective response to the wide range of potentially lethal problems which may occur suddenly in anaesthesia. A set of 25 articles describing additional precompiled responses collated into a manual for the management of any crisis under anaesthesia has been published electronically as companion papers to this article. This approach to crisis management should be applied to other areas of clinical medicine as well as anaesthesia.

Keywords: anaesthesia complications; crisis management; adverse events

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Quality Line
Qual. Saf. Health Care 2005 14: 153. [Extract] [Full Text] [PDF]

Crisis management during anaesthesia: the development of an anaesthetic crisis management manual

W B Runciman, M T Kluger, R W Morris, A D Paix, L M Watterson, and R K Webb
Qual. Saf. Health Care 2005 14: e1. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: tachycardia

L M Watterson, R W Morris, J A Williamson, and R N Westhorpe
Qual. Saf. Health Care 2005 14: e10. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: hypotension

R W Morris, L M Watterson, R N Westhorpe, and R K Webb
Qual. Saf. Health Care 2005 14: e11. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: hypertension

A D Paix, W B Runciman, B F Horan, M J Chapman, and M Currie
Qual. Saf. Health Care 2005 14: e12. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: myocardial ischaemia and infarction

G L Ludbrook, R K Webb, M Currie, and L M Watterson
Qual. Saf. Health Care 2005 14: e13. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: cardiac arrest

W B Runciman, R W Morris, L M Watterson, J A Williamson, and A D Paix
Qual. Saf. Health Care 2005 14: e14. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: problems associated with drug administration during anaesthesia

A D Paix, M F Bullock, W B Runciman, and J A Williamson
Qual. Saf. Health Care 2005 14: e15. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: awareness and anaesthesia

G A Osborne, A K Bacon, W B Runciman, and S C Helps
Qual. Saf. Health Care 2005 14: e16. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: embolism

J A Williamson, S C Helps, R N Westhorpe, and P Mackay
Qual. Saf. Health Care 2005 14: e17. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: pneumothorax

A K Bacon, A D Paix, J A Williamson, R K Webb, and M J Chapman
Qual. Saf. Health Care 2005 14: e18. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: anaphylaxis and allergy

M Currie, R K Kerridge, A K Bacon, and J A Williamson
Qual. Saf. Health Care 2005 14: e19. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: obstruction of the natural airway

T Visvanathan, M T Kluger, R K Webb, and R N Westhorpe
Qual. Saf. Health Care 2005 14: e2. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: vascular access problems

R J Singleton, S B Kinnear, M Currie, and S C Helps
Qual. Saf. Health Care 2005 14: e20. [Abstract] [Full Text] [PDF]

Trauma: development of a sub-algorithm

W M Griggs, R W Morris, W B Runciman, G A Osborne, and A D Paix
Qual. Saf. Health Care 2005 14: e21. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: sepsis

J A Myburgh, M J Chapman, S M Szekely, and G A Osborne
Qual. Saf. Health Care 2005 14: e22. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: water intoxication

M T Kluger, S M Szekely, R J Singleton, and S C Helps
Qual. Saf. Health Care 2005 14: e23. [Abstract] [Full Text] [PDF]

Crisis management during regional anaesthesia

M A L Fox, R W Morris, W B Runciman, and A D Paix
Qual. Saf. Health Care 2005 14: e24. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: recovering from a crisis

A K Bacon, R W Morris, W B Runciman, and M Currie
Qual. Saf. Health Care 2005 14: e25. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: laryngospasm

T Visvanathan, M T Kluger, R K Webb, and R N Westhorpe
Qual. Saf. Health Care 2005 14: e3. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: regurgitation, vomiting, and aspiration

M T Kluger, T Visvanathan, J A Myburgh, and R N Westhorpe
Qual. Saf. Health Care 2005 14: e4. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: difficult intubation

A D Paix, J A Williamson, and W B Runciman
Qual. Saf. Health Care 2005 14: e5. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: desaturation

S M Szekely, W B Runciman, R K Webb, and G L Ludbrook
Qual. Saf. Health Care 2005 14: e6. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: bronchospasm

R N Westhorpe, G L Ludbrook, and S C Helps
Qual. Saf. Health Care 2005 14: e7. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: pulmonary oedema

M J Chapman, J A Myburgh, M T Kluger, and W B Runciman
Qual. Saf. Health Care 2005 14: e8. [Abstract] [Full Text] [PDF]

Crisis management during anaesthesia: bradycardia

L M Watterson, R W Morris, R N Westhorpe, and J A Williamson
Qual. Saf. Health Care 2005 14: e9. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Runciman, W B, Kluger, M T, Morris, R W, Paix, A D, Watterson, L M, Webb, R K (2005). Crisis management during anaesthesia: the development of an anaesthetic crisis management manual. Qual Saf Health Care 14: e1-e1 [Abstract] [Full Text]