On Sunday, June 4th, 2023, during Euroanaesthesia 2023 in Glasgow, the Patient Safety and Quality Committee (PSQC) of the European Society of Anaesthesiology and Intensive Care (ESAIC) held the Patient Safety Experts Meeting, inviting participants from ESAIC, other international societies and industry partners. The Patient Safety Experts Meeting is a unique opportunity for experts worldwide to openly discuss the most current issues in patient safety in perioperative care. It is a regular event at Euroanaesthesia.
Dr Benedikt Preckel (Amsterdam, Netherlands), Chair of the PSQC, guided the meeting by first asking the participants:
What are the most important current patient safety matters in perioperative and intensive care?
The topic mentioned by the majority of safety experts during the conversation was staff shortages and productivity pressures in the post-pandemic era and their effects on medical errors and staff fatigue. Staff shortages seem almost universal – pronounced on both sides of the Atlantic. Staff shortages were also discussed at the International Forum on Perioperative Safety and Quality (ISQ), an ESAIC and the American Society of Anaesthesiologists (ASA) meeting on June 2nd, the day preceding EA23. It was suggested that we should look in depth at the reasons behind staff shortages and not just try to find solutions with the current resources.
Staff fatigue and burnout were repeatedly mentioned during the conversation as they affect physicians’ well-being as well as patient safety. It seems that the workforce is unable to cope with increased productivity pressures and resource shortages, leading to demotivation and disengagement with patient safety initiatives. High professional stress levels and professional dissatisfaction add to the problem as physicians and nurses retire early, causing challenges in training the new generation of anaesthetists. There is an imbalance between patient complexity (increasing) and anaesthetists’ experience (decreasing). At the same time, healthcare organisations seem to be under significant financial pressure that reduces the chances of investments in patient safety programs. It was suggested that if we look at improving professional well-being, we may be able to improve engagement with these initiatives.
The increased demand for anaesthesia services outside the operating theatre environment has led to other specialities and healthcare roles delivering sedation without predefined standards. This affects patient safety and professional stress and creates friction between specialities and services.
Medication errors and errors related to medication management equipment (infusion pumps) were also mentioned as a focus on improving patient safety in the next 12 months. Our industry partners suggested that improving our knowledge of all the features (embedded patient safety features) of the equipment we use will reduce errors and improve patient safety overall. Medication errors seem to be also affected by medication shortages and replacement with alternatives that sometimes confuse front-line staff.
Psychological safety and civility at work were also discussed as factors that affect professional satisfaction and patient safety. Dealing with disruptive personalities improves teamwork, and team members are more likely to feel part of the patient’s journey and contribute to patient safety in a meaningful way. In addition, we should improve patient awareness amongst all staff members in order to decrease errors and improve understanding that everyone’s role within the team is important and contributes to patient safety.
Another topic brought forward was Patient Empowerment and Involvement: We need to consider patients more as partners in achieving a better outcome, e.g., through pre-habilitation and shared decision-making programmes. In addition, patient safety should be viewed as a multidisciplinary approach involving surgeons, nurses, allied healthcare professionals, and patients.
Technology and how we interact with it within the healthcare system were raised. Our experts suggested that all systems (monitoring, medication delivery devices, electronic health records, artificial intelligence) should be critically assessed and standardised where possible in order to improve workflow, decrease confusion, improve information sharing and overall help us improve patient safety.
Sustainability was a big theme throughout EA23, and it seems it is at the forefront of anaesthetists’ minds worldwide. Our experts suggested that although sustainability and our environmental impact should be a priority, this should be delivered and balanced with patient safety in mind.
Other topics mentioned were patient safety in ICU, demands on anaesthetists to multitask even during anaesthesia delivery (clinical, managerial, educational roles& activities) and the effect on patient safety and GDPR implications on patient safety.
In the second part of the discussion, Dr Preckel asked the delegates:
What are the best strategies that we could recommend to address these topics?
The main issue that needs to be addressed is staff shortages in a constantly increasing workload as we deal with the post-pandemic backlog and operate on more people due to non-invasive surgery advancements. Our experts suggested assessing first what we deliver rather than what we should deliver and looking at the real reasons behind the staff shortages post-pandemic.
Adequate reimbursement of healthcare staff, good working conditions, and job satisfaction may help us improve the overall image of healthcare as a career choice. This will be enhanced by improving civility at the workplace by training in core values, leadership and how to diffuse tensions at the workplace. We should involve patients, help our colleagues prioritise well-being activities, and empower influencers.
Overall investment in education will contribute towards job satisfaction and potential staff retention as it will increase confidence and competence, which will increase patient safety.
At the same time, we should aim to stabilise workflow through multidisciplinary decision-making on surgical treatments based on meaningful outcomes. Multidisciplinary decision-making on indications for surgery was a successful model during the pandemic that needs to be re-examined and continued to be used.
Inter-site working was used successfully during the pandemic to address challenges with workflow and can be used in the post-pandemic era. This demands the standardisation of equipment and health records to maintain staff familiarity and patient safety.
The provision of sedation outside the borders of the operating suite is increasing while the availability of anaesthetists decreases, which has led to other specialities providing this role with non-standardised rules and training. In some countries, this has led to friction between providers as there is a financial perspective. The delegates suggested we look at who can help with this service provision, not focusing on the professional title but their competence. Nationwide training programmes for appropriate healthcare staff can facilitate this. In some countries, this change will demand legal changes too. Financial safety for anaesthetists sometimes influences attitudes and culture on the matter, and this should be discussed and addressed to have successful implementation programs.
Our industry partners suggested that they can play a role in educating the wider team and communicating the need for change in patient safety, contributing to the awareness of things that need to change and bringing patient safety to the forefront.
Our experts suggested that we should not focus on organisational financial pressures but on the overall healthcare budget, considering that 15% of it is spent on adverse events within the healthcare system. This will support the argument that investment in initiatives that improve patient safety (physicians’ well-being, prefilled syringes, education, etc.) is a viable and valuable investment.