ORIGINAL ARTICLE

Crisis management during anaesthesia: recovering from a crisis

A K Bacon¹, R W Morris², W B Runciman³ and M Currie⁴

¹ Consultant Anaesthetist, St John of God Hospital, Berwick, Victoria, Australia
² Director of Research and Development, Sydney Medical Simulation Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia
³ Professor and Head, Department of Anaesthesia and Intensive Care, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
⁴ Clinical Quality Coordinator, Goulburn Base Hospital, Goulburn; and Consultant in Clinical Quality, Southern Area Health Service, New South Wales, Australia

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

Preventing harm to the patient is the priority during a crisis. After a major incident, and especially when a patient has been harmed, there are a number of matters to be addressed: the ongoing care of the patient; documentation of the incident; investigation of the root causes; completion of reports; interviews with the patient and/or the next of kin, together with apologies and expression of regret; updates and ongoing support for friends and relatives; a word of thanks to the staff involved for their assistance; formal debriefing of staff for quality assurance and possibly ongoing support and a separate debriefing for psychological purposes; ensuring that the recommendations of the root cause analysis are carried out; or, failing that, that the issues are logged on a risk register.

The extent and depth of the follow up protocol depends on what, if any, harm may have been done. This may constitute completion of an incident report; notification of an equipment failure to a federal regulatory authority; arranging consultations with a mental health professional to manage psychological sequelae (especially following an awareness episode); follow up during weeks of intensive care treatment; or, when a death has occurred, a full medico-legal and/or coronial set of procedures. A précis is appended in an action card format.

Keywords: anaesthesia mishaps; protocols; legal processes; patient awareness; critical incident stress debriefing; unexpected death; crisis management

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Crises in clinical care: an approach to management

W B Runciman and A F Merry
Qual. Saf. Health Care 2005 14: 156-163. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Runciman, W B, Williamson, J A H, Deakin, A, Benveniste, K A, Bannon, K, Hibbert, P D (2006). An integrated framework for safety, quality and risk management: an information and incident management system based on a universal patient safety classification. Qual Saf Health Care 15: i82-i90 [Abstract] [Full Text]  
• 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]