RESUMEN
The National Academy of Medicine recognizes medical errors as a leading cause of death in the United States. Hospitals nationwide have acted to improve patient safety, quality of care, and system processes; however, no standards mandate assessment of the emotional impact of perioperative catastrophes on healthcare professionals. A cross-sectional descriptive study using a sample of 196 Certified Registered Nurse Anesthetists (CRNAs) tested the psychometric properties of an adapted version of the Perioperative Catastrophes Survey and administered this survey along with the Ways of Coping Questionnaire to measure CRNAs' perceptions, experiences, and responses associated with perioperative catastrophes. The adapted survey demonstrated acceptable internal consistency reliability (α = .893) and construct validity (factor analysis), with 4 subscales explaining 68.1% of the variance in the measure. The CRNAs scored similarly to anesthesiologists in a prior study conducted by Gazoni and colleagues, showing that memorable perioperative catastrophes have a negative emotional, cognitive, and functional impact. On the 8 Ways of Coping Questionnaire subscales, CRNAs with less than 10 years of experience reported significantly higher Escape-Avoidance behaviors compared with more experienced CRNAs (P = .016). Future research must examine perceptions of perioperative catastrophic events and coping mechanisms to identify providers at risk of negative consequences.
Asunto(s)
Adaptación Psicológica , Anestesia/efectos adversos , Actitud del Personal de Salud , Enfermedad Catastrófica/psicología , Errores Médicos/psicología , Enfermeras Anestesistas/psicología , Atención Perioperativa/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Estados UnidosRESUMEN
BACKGROUND: Most anesthesiologists will experience at least one perioperative catastrophe over the course of their careers. Very little, however, is known about the emotional impact of these events and their effects on both immediate and long-term ability to provide care. In this study, we examined the incidence of perioperative catastrophes and the impact of these outcomes on American anesthesiologists. METHODS: We sent a self-administered postal survey to 1200 randomly selected members of the American Society of Anesthesiologists. Participants were sent an advance letter, up to 2 copies of the survey, up to 2 reminder postcards, and a small cash incentive. Six hundred fifty-nine physicians (56%) completed the survey. RESULTS: Eighty-four percent of respondents had been involved in at least one unanticipated death or serious injury of a perioperative patient over the course of his/her career. Queried about the emotional impact of a "most memorable" perioperative catastrophe, >70% experienced guilt, anxiety, and reliving of the event with 88% requiring time to recover emotionally from the event and 19% acknowledging having never fully recovered. Twelve percent considered a career change. Sixty-seven percent of respondents believed that their ability to provide patient care was compromised in the first 4 hours subsequent to the event, but only 7% were given time off. CONCLUSION: A perioperative catastrophe may have a profound and lasting emotional impact on the anesthesiologist involved and may affect his or her ability to provide patient care in the aftermath of such events.
Asunto(s)
Anestesiología , Encuestas Epidemiológicas , Periodo Perioperatorio/efectos adversos , Médicos/psicología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Actitud del Personal de Salud , Muerte , Emociones , Femenino , Humanos , Masculino , Estados Unidos/epidemiologíaRESUMEN
Most anesthesiologists will experience the perioperative death of a patient or a major perioperative catastrophe in the course of their careers. Anesthesia training, however, does not prepare individuals to handle the aftermath of such a stressful event. Multiple surveys have shown that the death of a patient has a major emotional impact on up to 75% of health care providers involved, regardless of whether the death was expected or whether the patient was well known to the practitioner. Psychological recovery often takes weeks or months and is hampered by lack of emotional and professional support. Data indicate that the majority of anesthesiologists would prefer a more formal support structure, including the option to take time off from clinical work. Although a formal assessment of professional functioning after a perioperative catastrophe has not been done, the Association of Anaesthetists of Great Britain and Ireland instituted guidelines recommending support at multiple levels, and the "Adverse Event Protocol" available on the Anesthesia Patient Safety Foundation website provides a suggested series of steps to minimize patient injury and identify the cause of an adverse anesthesia event after it occurs. The negative consequences of failure to cope well after these events are significant to individuals and health care systems alike. Further study into the short-term and long-term impact of perioperative catastrophes on providers and health systems is needed. Additionally, education on how to handle the aftermath of perioperative catastrophes and formal support structures should be provided to practitioners at all levels of training.
Asunto(s)
Anestesia/efectos adversos , Anestesiología , Actitud del Personal de Salud , Actitud Frente a la Muerte , Complicaciones Intraoperatorias/psicología , Recolección de Datos , Emociones , Humanos , Estrés PsicológicoRESUMEN
OBJECT: Skull blockade for craniotomy may result in the reduction of sympathetic stimulation associated with the application of head pins ("pinning"), improvement in intraoperative hemodynamic stability, and a decrease in intraoperative anesthetic requirements. Postoperative benefits may include a decrease in pain, in analgesic requirements, and in the incidence of nausea and vomiting. The authors examined the potential benefits of a skull block in patients in whom a maintenance anesthetic consisting of sevoflurane and a titratable remifentanil infusion was used. In other studies examining the ability of a skull block to improve perioperative outcomes, investigators have not used remifentanil. METHODS: Thirty patients presenting for resection of a supratentorial tumor were prospectively enrolled. Patients were randomized into 2 groups as follows: 14 patients (skull block group) received a skull block with 0.5% ropivacaine at least 15 minutes prior to pinning, whereas the remaining 16 patients (control group) did not. RESULTS: Patients in the skull block group did not have a significant increase in blood pressure or heart rate with placement of head pins, whereas patients in the control group did. Nevertheless, there was no difference in blood pressure variability between the groups. The mean intraoperative concentration of sevoflurane (1.0% in both groups, p = 0.703) and remifentanil (0.163 microg/kg/min compared with 0.205 microg/kg/min, p = 0.186) used was similar in both groups. During the postoperative period, there was no difference in the 1-, 2-, or 4-hour visual analog scale scores; in the need for postoperative narcotic analgesia (0.274 morphine equivalent mg/kg compared with 0.517 morphine equivalent mg/kg, p = 0.162); or in the incidence of nausea or vomiting. CONCLUSIONS: Prospective analysis of perioperative skull blockade failed to demonstrate significant benefit in patients treated with a remifentanil infusion.