Significant Physiological Disturbances Associated With Non-Routine Event Containing and Routine Anesthesia Cases

Area of Science:

• Anesthesiology
• Patient Safety
• Clinical Quality Improvement

Background:

• Nonroutine events (NREs) are defined as deviations from ideal clinical care.
• Significant physiological disturbances (SPDs) are objective measures of patient compromise during anesthesia.
• The relationship between reported NREs and objectively measured SPDs requires further investigation.

Purpose of the Study:

• To compare the incidence of SPDs with the reporting of NREs in anesthesia.
• To determine if SPDs occur more frequently in cases with reported NREs compared to routine cases.
• To explore the clinical relevance of SPDs in relation to NREs.

Main Methods:

• Retrospective review of videotaped anesthesia care.
• Inclusion of 16 NRE-containing and 16 matched routine cases.
• Trained observer used custom software to identify SPDs based on predefined physiological parameter criteria.

Main Results:

• SPDs occurred in 88% of NRE cases versus 69% of routine cases.
• NRE cases had a higher incidence of SPDs (1.4 SPDs/case hour) than routine cases (0.8 SPDs/case hour).
• Approximately half of SPDs in NRE cases were clinically related to the reported NRE.

Conclusions:

• SPDs are more frequent in anesthesia cases involving NREs.
• A significant proportion of SPDs occur independently of reported NREs in both case types.
• Further research is necessary to understand the impact of NREs and SPDs on patient outcomes.