The role of incident reporting in continuous quality improvement in the intensive care setting

Publisher's copy made available with the permission of the publisherU. Beckman, W.B. Runcimanhttp://www.aaic.net.au/Article.asp?D=199606

Iatrogenic harm and anaesthesia in Australia

Publisher's copy made available with the permission of the publisherW. B. Runcimanhttp://www.aaic.net.au/Article.asp?D=200513

Space shuttle: Static stability characteristics and control surface effectiveness of the Boeing .00435 scale model space shuttle booster H-32

Experimental aerodynamic investigations were made in the Grumman 36-inch hypersonic wind tunnel on a .00435 scale model of the H-32 reusable space shuttle booster. The objectives of the test were to determine the static stability characteristics and control surface effectiveness at hypersonic speeds. Data were taken at M = 8.12 over a range of angles of attack between -5 and 85 deg at beta = 0 deg and over a range of side slip angles between -10 and 10 deg at alpha = 0 and 70 deg. Six component balance data and base-cavity pressure data were recorded

The Australian Incident Monitoring Study in intensive care: AIMS-ICU. An analysis of the first year of reporting.

Publisher's copy made available with the permission of the publisher Copyright © 1996 Australian Society of AnaesthetistsThe AIMS-ICU project is a national study set up to develop, introduce and evaluate an anonymous voluntary incident reporting system for intensive care. ICU staff members reported events which could have reduced, or did reduce, the safety margin for the patient. Seven ICUs contributed 536 reports, which identified 610 incidents involving the airway (20%), procedures (23%), drugs (28%), patient environment (21%), and ICU management (9%). Incidents were detected most frequently by rechecking the patient or the equipment, or by prior experience. No ill effects or only minor ones were experienced by most patients (short-term 76%, long-term 92%) as a result of the incident. Multiple contributing factors were identified, 33% system-based and 66% human factor-based. Incident monitoring promises to be a useful technique for improving patient safety in the ICU, when sufficient data have been collected to allow analysis of sets of incidents in defined “clinical situations”.U. Beckmann, I. Baldwin, G.K. Hart, W.B. Runcima

A tragic death: a time to blame or a time to learn?

W.B. Runciman and A. Merr

Space shuttle: Verification of transition reentry corridor at high angles of attack and determination of transition aerodynamic characteristics and subsonic aerodynamic characteristics at low angles of attack for the Boeing H-32 booster

Experimental aerodynamic investigations were made in a transonic wind tunnel on a 1/150-scale model of the Boeing H-32 space shuttle booster configuration. The purpose of the test was: (1) to verify the transonic reentry corridor at high angles of attack; (2) to determine the transonic aerodynamic characteristics; and (3) to determine the subsonic aerodynamic characteristics at low angles of attack. Test variables included configuration buildup, horizontal stabilizer settings of 0 and -20 deg, elevator deflections of 0 and -30 deg, and wing spoiler settings of 60 deg

Towards an International Classification for Patient Safety: key concepts and terms

Background. Understanding the patient safety literature has been compromised by the inconsistent use of language. Objectives. To identify key concepts of relevance to the International Patient Safety Classification (ICPS) proposed by the World Alliance For Patient Safety of the World Health Organization (WHO), and agree on definitions and preferred terms. Methods. Six principles were agreed upon—that the concepts and terms should: be applicable across the full spectrum of healthcare; be consistent with concepts from other WHO Classifications; have meanings as close as possible to those in colloquial use; convey the appropriate meanings with respect to patient safety; be brief and clear, without unnecessary or redundant qualifiers; be fit-for-purpose for the ICPS. Results. Definitions and preferred terms were agreed for 48 concepts of relevance to the ICPS; these were described and the relationships between them and the ICPS were outlined. Conclusions. The consistent use of key concepts, definitions and preferred terms should pave the way for better understanding, for comparisons between facilities and jurisdictions, and for trends to be tracked over time. Changes and improvements, translation into other languages and alignment with other sets of patient safety definitions will be necessary. This work represents the start of an ongoing process of progressively improving a common international understanding of terms and concepts relevant to patient safety. Keywords: patient safety, definitions, concepts, terminology, classificatio

Crisis management during anaesthesia: difficult intubation

BACKGROUND: Anaesthetists may experience difficulty with intubation unexpectedly which may be associated with difficulty in ventilating the patient. If not well managed, there may be serious consequences for the patient. A simple structured approach to this problem was developed to assist the anaesthetist in this difficult situation. OBJECTIVES: To examine the role of a specific sub-algorithm for the management of difficult intubation. METHODS: The potential performance of a structured approach developed by review of the literature and analysis of each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. RESULTS: There were 147 reports of difficult intubation capable of analysis among the first 4000 incidents reported to AIMS. The difficulty was unexpected in 52% of cases; major physiological changes occurred in 37% of these cases. Saturation fell below 90% in 22% of cases, oesophageal intubation was reported in 19%, and an emergency transtracheal airway was required in 4% of cases. Obesity and limited neck mobility and mouth opening were the most common anatomical contributing factors. CONCLUSION: The data confirm previously reported failures to predict difficult intubation with existing preoperative clinical tests and suggest an ongoing need to teach a pre-learned strategy to deal with difficult intubation and any associated problem with ventilation. An easy-to-follow structured approach to these problems is outlined. It is recommended that skilled assistance be obtained (preferably another anaesthetist) when difficulty is expected or the patient’s cardiorespiratory reserve is low. Patients should be assessed postoperatively to exclude any sequelae and to inform them of the difficulties encountered. These should be clearly documented and appropriate steps taken to warn future anaesthetists.A D Paix, J A Williamson and W B Runcima

Improving patients' safety by gathering information - Anonymous reporting has an important role

Bill Runciman, Alan Merry and Alexander McCall Smit

Australian GP attitudes to clinical practice guidelines and some implications for translating osteoarthritis care into practice

Abstract Clinical practice guidelines (CPGs) have been shown to improve processes of care and health outcomes, but there is often a discrepancy between recommendations for care and clinical practice. We sought to explore general practitioner attitudes toward CPGs, in general and specifically for osteoarthritis (OA) with the implications for translating OA care into practice. A self-administered questionnaire was conducted in January 2013 of a sample of 228 GPs in New South Wales and South Australia. Seventy-nine GPs returned questionnaires (response rate 35%). Nearly all GPs considered that CPGs support decision making in practice (94%) and medical education (92%). Very few respondents regarded CPGs as a threat to clinical autonomy, and most recognised that individual patient circumstances must be taken into account. Shorter CPG formats were preferred over longer and more comprehensive formats, with preferences being evenly divided amongst respondents for short, 2-3 page summaries, flowcharts or algorithms and single page checklists. GPs considered accessibility to CPGs to be important, and electronic formats were popular. Familiarity and use of The Royal Australian College of General Practitioners OA Guideline was poor with most respondents either not aware of it (30%: 95% CI 27% - 41%), had never used it (19%; 95% CI 12% - 29%), or rarely used it (34%; 95% CI 25% - 45%). If CPGs are to assist with the translation of evidence into practice, they must be easily accessible and in a format that encourages use. Key words: arthritis, primary care, evidence-based medicine, decision making Summary statement What is known about the topic? • Clinical practice guidelines (CPGs) can improve processes of care and health outcomes, however, there is often a gap between evidence-based recommendations for care and clinical practice. What does this paper add? • A better understanding of GP attitudes toward CPGs helps to explain potential barriers to the uptake of evidence-based practice and provides guidance on remedial action that may lead to better health outcomes.a National Health and Medical Research Council Program Grant (Australia, no.568612