Newsletter September 2023: How safe is your Anaesthesiology department? A self-assessment/peer-review tool for enhancing Patient Safety

Author:
Andrew Smith

The ESAIC has been running the PRiPSAIC (Peer Review in Patient Safety in Anaesthesiology and Intensive Care. The project’s aim was to create a number of patient safety peer-review networks in 4 European countries, train participating anaesthesiologists in evaluating patient safety using the methodology and visit process used in the Helsinki Declaration implementation evaluation project (1) and thereby share knowledge and experience in patient safety. In April 2022, the project visited two hospitals in Scotland, where Dr David Mackay hosted a visit at the Glasgow Royal Infirmary, a large teaching hospital in Glasgow and Dr Alvin Soosay hosted us at Forth Valley Hospital, a modern district general hospital some 30 km outside Glasgow. We were joined by Dr Aiste Urbonaite and Dr Gintarė Vitkutė, consultant and resident anaesthetist, respectively, at Kaunas Clinics, a university hospital in Kaunas, Lithuania. Also with us to see how the project worked were two UK trainees, Dr Mark Tan and Dr Claire Bond. The data collection process is shown in Box 1. In October 2022, the project visited Lithuania. Together with Dr Vilma Traškaité, Drs Urbonaite and Vitkuté hosted the visit at Kaunas Clinics, the visiting team included Dr Eija Junttila from Finland. The following day, Dr Liljia Paskalev was our host at Raseiniai Hospital, a district general hospital some 80km from Kaunas. From previous experience, we have emphasised to participating anaesthesiology departments, both before and during the visits, that PRiPSAIC is not an ‘inspection’; it is not a ‘test’ with correct and incorrect answers. Although a short report is produced for the host department summarising the visit, in our experience, the visiting team seldom uncovers any ‘surprises’. Participating departments are usually well aware of their safety strengths, but also areas for improvement. The PRiPSAIC visit provides an opportunity, which busy day-to-day clinical work may not allow, to create the time to use the simple, multi-faceted methodology to assess the formal safety processes such as protocols and checklists but also to explore the safety culture, and acknowledge and harness the existing experience and goodwill of staff.  

The programme continued with visits to Finland in December 2022. Here, Dr Petri Volmanen hosted us at Porvoo Hospital, a district general hospital some 60km from Helsinki, but administratively part of the Helsinki University Hospitals group. Dr Eija Junttila and Dr Maija-Liisa Kalliomäki were our hosts the following day at Tampere University Hospital—two colleagues from Moldova, Drs. Ghenadie Severin and Gheorghe Brânzǎ joined us for the Finnish visits in preparation for when the project moved to Moldova. It was satisfying to share one nation’s safety experience with another.  

In February 2023, the project visited, starting with the Oncological Institute in the capital, Chișinau, then Bâlți Hospital,  a large hospital some two hours’ drive from the capital in the north of the country. Our host in Chișinau was Dr Ruslan Baltaga, and it was a pleasure to see that some safety initiatives had been inspired by and introduced in the short time since our Moldovan colleagues had been to Finland. In Bâlți, Dr Gheorghe Brînza, who had joined us in Finland, organised our day and ensured we could see all relevant areas of the institution. In keeping with the peer review spirit of PRiPSAIC, several colleagues from Chișinau made the trip to Bâlți, including Drs Ruslan Baltaga, Ghenadie Severin, Ion Chesov and resident Dr Mihail Tiple. 

Evaluation/outputs 

The project has been a success. Our vision for PRiPSAIC, namely allowing the exchange of knowledge, ideas and practice between anaesthesiology departments, within and between countries, is being realised. The ‘cascade’ approach, where anaesthesiologists visit different countries to learn the project methodology and share their ideas and experiences, brought its benefits. In addition, through the visits, interviews and completing the Safety Attitude Questionnaires, more than 500+  personnel were stimulated to think about safety​. We have laid the foundations for regional’ peer review networks’​ and gathered vital intelligence to improve and simplify the visit process (see Box 1 ). Feedback from participants has been overwhelmingly positive and is shown in Box 2.  

The main product of the PRiPSAIC project will be a peer review ‘toolkit’ based on the above process for anaesthetic departments to use independently or as they visit each other in the name of patient safety. This will take a modular form, so participating departments and networks can do as much or as little as they like, at their own pace, and be available free of charge on the ESAIC website in due course. Finally, we are especially pleased that trainees have been able to be part of this project, as they are the future of anaesthesiology and the more they can be involved with patient safety, the better.  

We thank all participating anaesthesiologists, their departments, hospitals and national anaesthesiology societies for making the project successful. 

Reference 

1 https://www.esaic.org/uploads/2021/07/hd_8_final-report-evaluation-of-the-extent-of-implementation-of-the-helsinki-declaration-22-july-2020.pdf 

Box 1 ‘How safe is your anaesthetic department? The PRiPSAIC patient safety review process’ 

• Collect documents and protocols relating to patient safety: This should include, as a minimum, those relating to the items listed in the Helsinki Declaration for Patient Safety in Anaesthesiology].
• Complete the Annual Patient Safety Report using the template issued by the ESAIC*
• Copy, distribute and follow up Safety Attitudes Questionnaires to about 30 anaesthetists and theatre staff  (This is an ‘industry standard’, 32-item questionnaire that asks staff to rate their agreement with statements about teamwork, communication, management, how errors are handled, etc.)
• Find three staff to be interviewed during the visit (consultant, trainee anaesthetist and anaesthetic assistant/anaesthetic nurse) about their work, perceptions of safety, good practices, problems, etc. In our experience, staff often have many comments and ideas about safety in their workplace but are not always given the time or space to talk about these formally. The interviews usually last 30-45 minutes and provide this opportunity.
• Plan timetable for visit day to include Initial meeting/review of material collected with visitor (1 hour), interviews (allow 1 hour each), plus observation and tour of theatres/ICU at times appropriate to observe activities of interest. This might include drug storage, equipment checking, the WHO surgical briefing and ‘time out’, handover from theatre to recovery/ICU, etc.

Box 2   Feedback from participants 

“Having the visit was a pleasure…..hearing the opinions of the visitors in terms of how things could be improved was eye-opening.” 

“The project gave us lots to think about and stimulated useful discussion and self-reflection.” 

“The visit showed what might be improved, but also what we can be proud of in patient safety.” 

“The trip was great, I have seen many good things I will implement in my hospital.” 

“I liked how inclusive the project was – seniors, nurses, residents and surgeons were all involved.” 

“Being involved with PRiPSAIC allowed many safety elements to be formalised…the sharing of experience between departments is extremely valuable and should be the norm.”