Seamless Anesthesia Care

Abstract

674 Richard P. Dutton Editorial Views increase the risk for errors. 2 Advocates for the 80-h workweek have made a strong and evidence-based case for the appropriate relief of residents (and indeed all physicians) when duty hours become excessive. One potential solution would be to not assign at-risk personnel to cases that might run late, but this has obvious implications for both the cost and efficiency of staffing and the accumulation of experience by trainees. Another solution might be to not do the case at all, or to delay it until daylight hours. Although this is doubtless reasonable in some cases, in others it might create a barrier to timely care that directly affects patients. The reasonable and balanced solution, of course, is to learn how to manage handovers better. Handovers are not unique to health care, and there is a world of experience to draw from in improving the process. Nuclear power plants and air-traffic control towers must periodically handover complex real-time responsibilities from one operator to another, in environments where bobbles will have dire consequences. Navy watch-standers draw on centuries of history to keep the ship off the rocks when changing duty crews. In these activities, a culture has evolved in which the handover participants recognize the risks of the process and engage in a structured and systematic activity to insure the accurate transmission of relevant data. We should do no less in the operating room. Anesthesia residents should be trained in a team-oriented, checklist-driven handover process from their first day in the operating room, guided by the commitment of their grizzled seniors in a team-based culture that emphasizes the best possible outcome for the patient. Vigilance remains the watchword of anesthesiology. Saa-ger et al. have spotlighted an area where we can learn to do better. Our goal should be a future state in which we can proudly cite evidence showing our ability to manage handovers without imperiling patient care.