First-year residents who were allowed to nap for 20 minutes at midday had improved cognitive performance and fewer attentional failures than residents who did not nap. However, the study did not control for potential confounders, such as residents' caffeine intake.

The use of closed claims data to identify risk exposures, highlight safety issues, and drive improvement changes have been applied in ambulatory care, surgery, emergency medicine, and obstetrics. This study uses a previously described database to compare liability profiles in obstetric anesthesia before and after 1990. Investigators found that while the proportion of maternal death and newborn death or brain damage claims decreased in recent years (though still a leading cause), maternal nerve injury and back pain increased in later claims. Delays in anesthesia care, substandard care, and poor communication between the obstetrician and anesthesiologist are identified as preventable causes of newborn injury.

… improved monitoring strategies. … Bhananker SM, Posner KL, Cheney FW, Caplan RA, Lee LA, Domino KB. Injury and liability …

… … Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the difficult airway: a closed …

A retrospective analysis of the American Society of Anesthesiology Closed Claims Study, this article describes the types of adverse outcomes for which claims were filed. The authors report that three mechanisms of injury (inadequate ventilation, esophageal intubation, and difficult tracheal intubation) accounted for three-fourths of the adverse respiratory events. They further describe the median costs of settlements awarded, characteristics of events in which care was deemed substandard, and claims in which the outcome was considered preventable. The authors advocate for a better understanding of respiratory risks and methods to more quickly collect data upon recognition of an adverse outcome.

The authors report a controlled trial to investigate whether knowledge of the severity of the outcome of a medical adverse event can influence expert judgment of its preventability. The authors obtained 21 standardized case abstracts in anesthesiology representing eight recognized classes of anesthetic complications. For each case, the authors prepared a matching case identical in every way, with the exception that if the true case resulted in mild reversible injury, the matching case was made to result in severe irreversible injury and vice versa. When reviewed by an expert panel of experienced anesthesiologists, the care in cases with a severe outcome was approximately 30% more likely to be judged as substandard in comparison with the identical case with a favorable outcome. The authors discuss the known weaknesses of expert review and implicit judgment and the implications of their data for quality assurance and other forms of care review.