Perceived barriers to computerised quality documentation during anaesthesia: a survey of anaesthesia staff

BACKGROUND: Underreporting of intraoperative events in anaesthesia is well-known and compromises quality documentation. The reasons for such omissions remain unclear. We conducted a questionnaire-based survey of anaesthesia staff to explore perceived barriers to reliable documentation during anaesthesia. METHODS: Participants anonymously completed a paper-based questionnaire. Predefined answers referred to potential barriers. Additional written comments were encouraged. Differences between physician and nurse anaesthetists were tested with t-tests and chi-square tests. RESULTS: Twenty-five physician and 30 nurse anaesthetists (81% of total staff) completed the survey. The reported problems referred to three main categories: (I) potential influences related to working conditions and practices of data collection, such as premature entry of the data (indicated by 85% of the respondents), competing duties (87%), and interfering interruptions or noise (67%); (II) problems referring to institutional management of the data, for example lacking feedback on the results (95%) and lacking knowledge about what the data are used for (75%); (III) problems related to specific attitudes, e.g., considering these data not useful for quality improvement (47%). Physicians were more sceptical than nurses regarding the relevance of these data for quality and patient safety. CONCLUSIONS: The common perceived difficulties reported by physician and nurse anaesthetists resemble established barriers to incident reporting and may similarly act as barriers to quality documentation during anaesthesia. Further studies should investigate if these perceived obstacles have a causal impact on quality reporting in anaesthesia. TRIAL REGISTRATION: ClinicalTrials.gov identifier is NCT01524484. Registration date: January 21, 2012

The chemistry of sulfur and nitrogen species in a fog system A multiphase approach

Concentration and phase distribution of sulfur and nitrogen species during a particular fog episode in the Po Valley are experimentally described in this paper. Chemical measurements were carried out simultaneously at different heights within the fog layer, up to 50 m. Microphysical and meteorological parameters necessary for the description of the fog multiphase system were also concurrently measured as a function of height. The fog cycle (formation, evolution, dissipation) is described in terms of the total acidity of a unit volume of air containing gas species, interstitial aerosol particles and fog droplets. The fog system was not closed and input of acidic and basic components was observed during fog evolution. The driving force which determines the acidity of the fog multiphase atmospheric system was found to be the presence of NH 3 and its partitioning among the different phases. A strong decrease of fog water pH (from 5.6 down to 2.8) was observed during fog evolution and was attributed to a HNO 3 input to the system. These acidic and basic inputs are described in terms of a titration/back-titration process of the fog system. The SO 2 oxidation process in fog water was found to be of minor importance in determining the SO 4 = concentration within the fog system, due to both low SO 2 concentration and limited oxidant availability during the experiment. DOI: 10.1034/j.1600-0889.1992.t01-4-00005.