What are ways to improve task management in anesthesiology?

Improving Task Management in Anesthesiology

Implement pre-assigned task allocation during team briefings, utilize checklists for routine and crisis situations, and adopt automated electronic record systems to reduce cognitive load and prevent critical omissions. 1, 2

Team-Based Task Allocation and Preparation

Pre-assign specific tasks to each team member during the surgical pause or team briefing before every case. 1 This approach is particularly critical for high-risk situations where:

• Each team member receives a designated fire management task (e.g., removing the tracheal tube, turning off airway gases) 1
• Team members understand they must perform their pre-assigned task immediately without waiting for others to act 1
• Once completed, team members assist others with incomplete tasks 1

This structured approach prevents the delays and confusion that occur when multiple people wait for someone else to take action during emergencies. 1

Checklist Implementation

Deploy anaesthesia-specific checklists for both routine procedures and crisis management to significantly reduce human error and improve adherence to guidelines. 3, 2

Evidence for Checklist Efficacy

• Checklists improve technical performance scores (24/30 vs 18/30, p=0.002) and non-technical skills scores (56.5/60 vs 48.5/60, p=0.024) during simulated malignant hyperthermia crises 3
• They reduce critical task omissions, with 8 of 9 essential tasks completed at least 75% of the time when using checklists versus only 4 of 9 tasks without checklists 4
• 92% of studies demonstrate that checklists decrease human error, improve patient safety and teamwork, and increase quality of care 2

Display easily visible protocols for prevention and management of emergencies in every operating room where risk exists. 1 This ensures immediate access to structured guidance during time-critical situations.

Automated Electronic Record Systems

Implement automated electronic anaesthetic record systems integrated with the hospital's electronic health record to reduce documentation burden and improve accuracy. 1

• Automated systems free cognitive resources by eliminating manual charting during critical periods 1
• Integration ensures comprehensive information capture from all monitoring devices 1
• This reduces task fragmentation, which doubles medication errors when providers must simultaneously accomplish multiple tasks 1

Workload Management and Resource Allocation

Adjust workload to match available staff and carefully monitor adequacy of resources to effectively cope with potential crisis situations. 1

Critical Workload Considerations

• When supervising two operating rooms, the risk of being unable to intervene ranges from 87% (short cases) to 40% (long cases) 1
• Risk increases further when supervising three rooms, with inability to respond occurring on 99% of days 1
• Set workload ratios that ensure an anaesthetist can effectively manage complications at any moment 1

Account for high-risk periods when allocating tasks: 1

• Night-time periods after midnight are particularly conducive to errors 1
• Sleep inertia after sudden awakening can impair cognitive function for several dozen minutes 1
• Residents with lower workload demonstrate better performance 1

Fatigue Management Strategies

Develop organizational policies targeting fatigue risk at all levels, including limitation of on-duty periods, mandatory rest periods (including short naps), and respect for existing work hour legislation. 1

Team-Based Fatigue Mitigation

• Inform teammates of one's fatigue state to foster group vigilance without judgment 1
• Utilize risk securitization tools during fatigued states 1
• Consider short-duration postponement of risky procedures or operator changes when technically feasible 1
• Factor caregiver fatigue into the risk-benefit balance during decision-making for invasive procedures 1

Optimizing Work Environment

Maintain an adapted work atmosphere with relaxed communication and appropriate sound levels to optimize technical and non-technical performance during crises. 1

• Interruptions while prescribing nearly triple medication errors 1
• Task fragmentation doubles error rates 1
• Include ergonomics as a discussion point in team briefings to develop a culture of optimal workspace setup 1

Continuous Presence and Supervision

Ensure continuous presence of an appropriately trained anaesthetist with the patient at all times during anaesthesia or sedation, at least until WHO sign-out completion and handover to trained staff. 1

• This continuous presence is the cornerstone of patient safety 1
• Trainees must be appropriately supervised at all times, sometimes requiring direct consultant supervision 1
• For regional anaesthesia without sedation, specific protocols allow brief absences with immediate availability for 15 minutes, then 2-minute response capability 1

Monitoring and Alarm Management

Set patient-specific alarm limits before use and enable audible alarms during anaesthesia to provide early warning of deteriorating conditions. 1

• Monitoring reduces risks by detecting error consequences and providing early warning of patient deterioration 1
• Human factors and ergonomics are key to safe healthcare delivery, as human error is inevitable 1
• Safe task performance requires both technical and non-technical skills 1

Common Pitfalls to Avoid

• Do not wait for another team member to act before performing your pre-assigned task during emergencies 1
• Avoid supervising more than two operating rooms simultaneously given the high probability of being unable to respond to complications 1
• Do not ignore fatigue signals—deteriorating perception of fatigue occurs after long uninterrupted work periods, creating an illusion of performance 1
• Prevent task fragmentation and interruptions during medication prescribing and other high-risk activities 1

Human factors and non-technical skills are as critical as technical proficiency for safe task management in anesthesiology. 1