Instructional review improves performance of anesthesia apparatus checkout procedures

Checkout recommendations for anesthesia apparatus are promoted as a means of improving patient safety. We sought to determine residents' performance of institutional checkout procedures and the degree of their improvement after instructional video review. Twenty-nine residents performing a list of pre-use checkout procedures were videotaped (VT1) prior to randomization into a Control or Test group. The Control group had a second videotaping (VT2), whereas the Test group received instructional review of VT1 prior to VT2. Control and Test subjects then had instructional review of all tapes. A blinded investigator scored all tapes without interacting with any subject. Control and Test video scores were compared at VT1 and VT2 using analysis of variance. Differences were sought between the clinical anesthesia (CA) 1-, 2-, and 3-yr residents. Percent "perfect," "partial," or "no" completion of each criterion was calculated to determine performance and improvement. A low-performance rate of 69% (20.6/30) occurred in VT1, significantly improving to 81% (24.2/30) in the Test group after intervention (P < 0.0021) with significant reductions in criteria that were totally missed. Anesthesia apparatus checkout procedures are improved after intensive training sessions, although high rates of completion are not achieved. This performance deficit may have implications for the ability of physicians to detect anesthesia machine faults.