THE ANESTHETIST'S TASKS
The investigation of a complex work environment typically starts
with a task analysis (a set of reviews of this technique was published in the journal
Human Factors[184]
).
One can perform an abstract analysis of the work goals and constraints and then
derive the tasks required to achieve the goals. Alternatively, one can observe what
skilled practitioners actually do in their work and classify these actions into task
elements. Often the techniques are combined. In this section, the anesthetist's
task is examined in the abstract. In the following section, the empirical task analysis
approach is reviewed. There are two distinct phases of anesthetic care: (1) preoperative
evaluation, planning, and preparation; and (2) conduct of the anesthetic regimen
and immediate postoperative care.
Preoperative Evaluation and Planning
There are few data on how well anesthetists identify important
patient conditions through history-taking and physical examination (see Chapter
25
). A frequent organizational
obstacle to the anesthetist's evaluation task is difficulty in obtaining the patient's
previous medical records. The performance of anesthetists in selecting appropriate
laboratory tests has been found to be relatively poor. Roizen[185]
(see Chapter 27
) states the
following:
Even when physicians agree to reduce testing by using specific, agreed upon criteria
for selectively ordering tests based on history and physical examination, they still
make a surprising number of mistakes when ordering tests. Approximately 30 to 40
percent of patients who should have certain tests ... do not get them, and 20 to
40 percent of patients who should not have tests are subjected to them.
Roizen has argued for the automation of routine patient questioning
and selection of laboratory tests and has participated in the development of commercial
devices to do so. Whether these devices, in combination with human follow-up for
patients with medical problems, will improve the efficiency and accuracy of preoperative
evaluation remains to be determined. The performance of anesthetists at interpreting
electrocardiograms (ECGs)[186]
and chest radiographs
[187]
also appears to be poor relative to specialists
in these fields. The extent to which this factor influences the design of anesthetic
plans or patient outcomes is unknown.
