Assessing Risk Factors in Anesthesia

An innovative attempt was made by a team of engineers and anesthesiologists to apply a technique called "probabilistic risk analysis" (PRA) to model cascading risks and the effects of different types of organizational interventions.^{[321] [322]} PRA has been used extensively in nuclear power and other high-hazard industries (for example, it was used for analysis of risks from space shuttle thermal tile failure). Complete PRA models are very complex and extensive. In the anesthesiology study, a highly simplified PRA model was used to assess the feasibility of applying this technique to health care. The PRA analysis of organizational changes in anesthesia suggested that patient risk could be reduced best by closer supervision of residents; the use of patient simulators for training and periodic recertification, and regular medical examinations of anesthetists for fitness-for-duty. The PRA technique may be applied to more detailed probabilistic models in future studies.

A group in Tuebingen, Germany, performed a process-oriented systems analysis at a medical university hospital, assessing the anesthesia work system's ability to regulate variances and disturbances in the work process.^[323] These investigators showed that the internal work process can be regulated well, but high interdependence of the anesthesia work system with other systems requires extensive coordination activities.