The ASA has sponsored two new Patient Safety Videotapes in the ongoing series. Both were filmed recently in Palo Alto, CA, and will be distributed together this summer by Glaxo Wellcome representatives to anesthesia departments in U.S. hospitals having 100 or more beds.

Production Pressure

“Production Pressure in Anesthesiology” is number 27 in the series. This videotape addresses the common existence of production pressure within the anesthesia community. Production pressures are defined as “overt or covert forces or incentives on personnel to make production rather than safety their highest priority.” Questions about whether institutional or financial pressures on anesthesia providers both to cut corners and to go faster, even to the point of compromising patient safety, have been widely raised recently.

In this presentation, production pressure can be seen in action via four scenarios in which haste results in unintentional errors in judgment and performance. Anesthesiologists should never be pressured into deviations from safe practice patterns because of inadequate information, equipment, or personnel. The frequent occurrence of pressure-induced safety risks is clearly documented in data presented from a survey of more than 600 anesthesiologists.

The conclusions reached are that the sources of pressure are multifactorial and should be recognized and resisted. Safety mandates that must be observed despite forces to the contrary are presented.

J. S. Gravenstein, MD, of the University of Florida at Gainesville, and David M. Gaba, MD, and Steven K. Howard, MD, of the VA Palo Alto Healthcare System and Stanford University are consultant anesthesiologists on this program.

The Fatigue Factor

Videotape number 28 is entitled, “Fatigue: Implications for the Anesthesiologist.” This program draws attention to the potential for catastrophic consequences when overworked anesthesiologists suffer from fatigue enough to compromise their performance. A series of scenarios that take a busy anesthesiologist through a typical 30-hour “day” point out the dangers, to both clinicians and patients, resulting from fatigue. A parallel is drawn between the practice of anesthesiology and other high-risk occupations in industries such as commercial aviation which, unlike medicine, has recognized, researched, and taken steps to prevent fatigue-related accidents.

This videotape reviews the physiology of sleep and the performance impairments that occur when people are sleep-deprived. The concept of sleep deficit is explored and data are presented that document a previously unrecognized level of chronic sleep deprivation in a representative sampling of anesthesiologists.

Importantly, practical strategies to decrease the impact of fatigue-induced performance impairment are presented. Fatigue countermeasures such as improving sleep hygiene and allowing for duty breaks and naps are discussed in detail.

The consultant anesthesiologists for this program are Steven K. Howard, MD, and David M. Gaba, MD, of the VA Palo Alto Healthcare System and Stanford University, who have published extensively in recent years on human factors analysis and issues regarding anesthesia practice.