Patient Safety/Quality of Care

Teaching anesthesia during surgery may be a distraction that reduces the vigilance of anesthesia care

Anesthesiologists may be less vigilant about anesthesia care when teaching others about anesthesiology while they are assisting with a surgery, suggests a study that was supported in part by the Agency for Healthcare Research and Quality (HS11521 and HS11375). Matthew B. Weinger, M.D., of the University of California-San Diego, and his colleagues studied faculty anesthesiologists, nurse anesthetists, and resident anesthesiologists during 24 elective general anesthesia cases at two medical centers. In 12 cases, the anesthesiologists were teaching either a first-month anesthesia resident or a fourth-year medical student doing an anesthesiology clerkship. No teaching was conducted in the other 12 cases.

The researchers monitored anesthesiologists' heart rates (physiological workload) and calculated workload density at 1- and 5-minute intervals by multiplying the duration of each task performed in that interval by a task-specific workload factor score (for example, a laryngoscopy had a higher score than mere observing). Anesthesiologists who were teaching took a significantly longer time to respond to an alarm light during anesthesia induction and emergence than anesthesiologists who were not teaching, suggesting decreased vigilance to anesthesia care while teaching.

Clinicians' heart rates, observer- and self-reported workload scores, and non-teaching workload density were consistently increased during anesthesia induction and emergence compared with anesthesia maintenance. Workload density during teaching cases was significantly greater than during non-teaching cases.

See "Multiple measures of anesthesia workload during teaching and nonteaching cases," by Dr. Weinger, Swapna B. Reddy, B.S., and Jason M. Slagle, M.S., in the Anesthesia and Analgesia 98, pp. 1419-1425, 2004.

Editor's Note: In another AHRQ-supported study on a related topic, researchers used anesthesiology as a test environment to point out the value of videotape to analyze clinical care as a means to enhance patient safety. For more details, see Weinger, M.B., Gonzales, D.C., Slagle, J., and Syeed, M. (2004). "Video capture of clinical care to enhance patient safety." (AHRQ grants HS11375 and HS11521). Quality and Safety in Health Care 13, pp. 136-144.

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