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A simulation design for research evaluating safety innovations in anaesthesia *
Author(s) -
Merry A. F.,
Weller J. M.,
Robinson B. J.,
Warman G. R.,
Davies E.,
Shaw J.,
Cheeseman J. F.,
Wilson L. F.
Publication year - 2008
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2008.05638.x
Subject(s) - medicine , patient safety , clinical trial , anesthesia , health care , pathology , economics , economic growth
Summary It is notoriously difficult to obtain evidence from clinical randomised controlled trials for safety innovations in healthcare. We have developed a research design using simulation for the evaluation of safety initiatives in anaesthesia. We used a standard and a modified scenario in a human‐patient simulator, involving a potentially life‐threatening problem requiring prompt attention – either a cardiac arrest or a failure in oxygen supply. The modified scenarios involved distractions such as loud music, a demanding and uncooperative surgeon, telephone calls and frequent questions from a medical student. Twenty anaesthetics were administered by 10 anaesthetists. A mean (SD) of 11.3 (2.8) errors per anaesthetic were identified in the oxygen failure scenarios, compared with 8.0 (3.4) in the cardiac arrest scenarios (ANOVA: p = 0.04). The difference between the combined standard scenarios and the combined modified scenarios was not significant. The mean rate of errors overall was 9.7 per simulation, with a pooled SD of 4.46, so in future studies 21 subjects would provide 80% statistical power to show a reduction in error rate of 30% from baseline with p≤0.05. Our research design will facilitate the evaluation of safety initiatives in anaesthesia.