Production pressure, medical errors, and the pre-anesthesia checkout

Medical errors have rightly become an important societal and professional issue. While anesthesiology as a specialty has been at the forefront of the patient safety movement it is also subject to the same pressures for efficiency as any other business. Whether this pressure is at odds with the delivery of safe care is not yet clearly delineated. However, a theoretical framework of unsafe practices as well as a body of literature from other industries such as aviation suggests that production pressure may lead to unsafe practice. Also, it is unlikely that the common pressures encountered in the operating room (e.g., to reduce turnover times) have any positive financial impact for anesthesiology departments unless extra cases can be done each day. We include in this review a potential area for improvement and further research for anesthesiologists, the preanesthesia induction timeout. This crucial period of any anesthetic involves a high workload and is often the most hurried; this combination may be setting practitioners up to make errors. We suggest the use of checklists and timeouts to formalize this period and propose a useful seven-point list of crucial items and events needed before each anesthetic.