The German Critical Incident Reporting System for Anesthesiology: CIRSains
Andreas Stefan Welker1, Michael St Pierre, Wolfgang Heinrichs
1From the *Clinic of Anaesthesiology, Intensive Care Medicine and Pain Therapy, HSK, Dr. Horst Schmidt Clinic, Wiesbaden, Germany; †Clinic of Anaesthesiology, University of Erlangen, Erlangen, Germany; ‡AQAI GmbH, Mainz, Germany; and §Professional Association of German Anaesthiologists and German Society of Anaesthesiology and Intensive Care Medicine, Nuremburg, Germany.
Background:
In June 2010, the Helsinki Declaration was passed. As a result, an online nationwide critical incident reporting system named CIRSmedical Anaesthesiology (CIRSains) was implemented in Germany. The aim of the article is to evaluate CIRSains for practicability and to provide solutions to the problems detected during evaluation.
Methods:
Every medical staff member could take part voluntarily. Data were deidentified. All reports for anesthesiology (1548) were taken into account. Data collection lasted from April 2010 to February 2011. Incident report forms were classified according to World Health Organization and National Patient Safety Agency taxonomy.
Results:
Most reports (1347; 87.0%) contained American Society of Anaesthesiologists (ASA) classification, stratifying the severity of patients' underlying disease. Only some mentioned patients' age, even less sex. Physicians filed more reports than nurses. Staff-related factors constituted 794 (51.3%) choices, with attention issues (433; 28.0%) and routine violations (143; 9.2%) leading. Clinical processes (443; 28.6%), medication (347; 22.4%), and medical devices (530; 34.2%) were the leading incident category types. Most consequences ranged in low (398; 25.7%) and moderate (826; 53.4%) risk categories. Mitigating factors were barely mentioned.
Conclusion:
CIRSains displays the German effort to establish the Helsinki declaration. Easy accessibility, anonymity, medicolegal safety, and high flexibility resulted in high usage. The study shows a sufficient practicability of the database, but the data input has to be improved for better scientific use, for example, by implementation of more multiple-choice questions. Given the high magnitude and importance of patient safety problems, improving CIRSains remains a priority for the future.
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