A study of risk evaluation and quality control in anaesthesia

Because the community expects increasingly high standards of medical performance, there is every reason for meticulous recording of the problems which can arise during one's work. The aim must be to quantify risks, identify problem areas and create an instrument to facilitate quality control and the analysis of critical events. In the course of one calendar year, problems occurring in all 14,735 patients who underwent anaesthesia in a regional hospital were recorded systematically, classified as to their degree of severity, and entered alongside relevant patient data into individual anaesthesia records; following operation, the information was fed into a data base. The system proved to work well in a heavily committed anaesthesia unit. The main methodological difficulties lay in acquiring the necessary discipline, applying consistently the definitions of complications and controlling data. In all 655 problems were registered in 599 patients, 80 of these being severe; among the most prominent were hypotension, difficulties with intubation, cardiac arrhythmias and laryngeal spasm. Such a system of registration promotes increased alertness to questions of patient safety. Registration of problems is now integrated into the unit's permanent routines.