Systems involving people, tools, technology, and work environments must interact effectively to ensure the delivery of safe, effective care. This narrative review uses a sociotechnical perspective to explore the inter-relationship between technology and the human work environment during the delivery of anesthesia in the operating room. The authors discuss systems-level approaches, such as such as surgical safety checklists, as well as the role of resilience and new technologies (i.e., artificial intelligence).

Simulation training is a valuable tool to improve patient care. In this study, researchers explored latent safety threats identified during multidisciplinary simulation-based team training delivered to 21 hospitals in New Zealand. Common latent threats were related to knowledge and skills, team factors, task- or technology-related factors, and work environment threats.

… and reduce error. … Pinnock F,  Ritchie D, Gallagher S, et al. The efficacy of mindful practice in improving …

The design of research in patient safety has garnered controversy. This commentary suggests that approaches beyond the randomized controlled trial are needed to spur the rapid development of evidence needed to drive progress.

As use of anesthesia outside the operating room increases, the hazards associated with the practice are becoming more evident. This review discusses sedation in the ambulatory setting and highlights how factors related to the care environment, equipment, and teamwork contribute to the risks.

Simulations are increasingly used for teamwork training in scenarios ranging from emergency departments to pediatrics. Simulated operating room (OR) scenarios have also been used for studying the effect of surgical checklists in crises. Despite widespread implementation, previous systematic reviews have raised concerns about variation in type and intensity of simulation programs, as well as the paucity of high-quality studies confirming their effectiveness. This review examined simulation training for integrated multidisciplinary OR teams and found that current simulation studies lack standardization of techniques and measurement methods. While participants in these training programs generally felt that they were realistic and useful, significant barriers were noted, including recruitment, fidelity of surgical models, and costs. The authors suggest that future work focus on how best to overcome these barriers.

Anesthesiologists were observed to violate sterile technique frequently when administering medications in a simulated setting. These protocol violations could contribute to hospital-acquired infections.

Drug administration errors are a major safety concern in anesthesiology, as even routine cases can require administration of several high-risk medications. In this randomized controlled trial, a novel system for drug administration was evaluated in comparison with usual anesthesia practice. The new system was designed according to human factors engineering principles and included proven safety measures such as barcode medication administration. Although fewer overall errors occurred with the new system, the reduction in administration errors occurred only when barcoding was performed consistently and safety alerts were heeded. The anesthesia field has long been a leader in patient safety, and in fact, some of the earliest studies in the patient safety field evaluated the role of human factors in anesthesia medication administration errors.

The author suggests that greater focus on the system, widespread incident reporting, and long-term financial investments will help foster a safety culture in anesthesia.