Task Management in Anesthesiology
Pre-assign specific tasks to each team member during the surgical pause or team briefing before every case to prevent delays and confusion during emergencies, and implement automated electronic record systems to reduce documentation burden while ensuring continuous presence of an appropriately trained anesthesiologist with the patient at all times. 1
Team-Based Task Allocation
Structured pre-assignment of tasks is the cornerstone of effective crisis management in the operating room. Each team member must receive a designated task (such as removing the tracheal tube, turning off airway gases, or administering medications) and understand they must perform their pre-assigned task immediately without waiting for others to act. 1 Once their own task is complete, team members should assist others with incomplete tasks to ensure efficient completion of all critical actions. 1
- Display easily visible protocols for prevention and management of emergencies in every operating room to ensure immediate access to structured guidance during time-critical situations. 1
- Checklists significantly improve both technical and non-technical performance during crisis management, with studies showing improved adherence to guidelines and faster administration of critical medications (e.g., complete initial dantrolene dose administered 6.7 minutes faster with checklist use). 2
- The World Health Organization Surgical Safety Checklist improves safety through better teamwork, communication, and consistency of care, reducing critical workload by eliminating issues already controlled for. 3
Automated Documentation Systems
Implement automated electronic anesthetic 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 and ensure comprehensive information capture from all monitoring devices. 1
- Task fragmentation doubles medication errors when providers must simultaneously accomplish multiple tasks, making automation of routine documentation essential for safety. 1
- Manual charting during critical periods diverts attention from patient monitoring and clinical decision-making. 1
Workload Management and Supervision Ratios
Adjust workload to match available staff and carefully monitor adequacy of resources to effectively cope with potential crisis situations. 1 The evidence on supervision ratios is particularly striking:
- Supervising two operating rooms poses an 87% risk of being unable to intervene for short cases and 40% risk for long cases. 1
- This risk increases further when supervising three rooms, making such arrangements unsafe. 1
- Set workload ratios that ensure an anesthetist can effectively manage complications at any moment, accounting for high-risk periods (induction, emergence, critical surgical steps) when allocating tasks. 1
Continuous Presence Requirements
Ensure continuous presence of an appropriately trained anesthetist with the patient at all times during anesthesia or sedation, at least until WHO sign-out completion and handover to trained staff. 1 This continuous presence is the cornerstone of patient safety and a central element of risk management. 1, 4
- Trainees must be appropriately supervised at all times, sometimes requiring direct consultant supervision depending on case complexity and trainee experience level. 1
- Novice providers exhibit longer task durations (e.g., monitoring screens for 13 seconds vs. 7 seconds in experienced providers) and increased subjective workload despite performing fewer tasks per minute. 5
Fatigue Management
Develop organizational policies targeting fatigue risk at all levels, including limitation of on-duty periods, mandatory rest periods, and respect for existing work hour legislation. 1
- Inform teammates of one's fatigue state to foster group vigilance without judgment, and utilize risk assessment tools during fatigued states to help mitigate risks. 1, 6
- Factor caregiver fatigue into the risk-benefit balance during decision-making for invasive procedures to ensure patient safety. 1
- Ignoring fatigue signals can lead to deteriorating perception of fatigue, creating an illusion of performance. 1
Monitoring and Alarm Configuration
Set patient-specific alarm limits before use and enable audible alarms during anesthesia 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, including proper positioning of monitors at eye level and in front of the anesthetist. 7
- Response latency to vigilance tasks increases at times of increased workload (e.g., during induction), making proper alarm configuration critical. 5
Ergonomic Considerations for Task Efficiency
Position the patient at the level of the anesthetist's umbilicus (T10 dermatome or waist) to facilitate mask holding and drug administration without bending. 7
- Configure anesthetic machines appropriately (left-handed machines to the left, right-handed to the right) to avoid requiring the anesthetist to lean forward repeatedly or turn their head to view monitors. 7
- Bring injection ports close to the anesthetist by gently flexing the patient's arm or using infusion extensions with three-way taps. 7
Critical Pitfalls to Avoid
- Never wait for another team member to act before performing your pre-assigned task during emergencies, as this prevents delays and ensures efficient task completion. 1
- Avoid supervising more than two operating rooms simultaneously given the high probability of being unable to respond to complications. 1
- Prevent task fragmentation and interruptions during medication prescribing and other high-risk activities, as this is essential for error prevention. 1
- Do not use decision-making checklists as mere box-checking exercises; they should actively monitor thought processes and help identify cognitive errors from heuristics (mental shortcuts). 6