Preventable anesthesia-related adverse events at a large tertiary care center: a nine-year retrospective analysis.
Approach to Improving Safety
Setting of Care
Anesthesiologists have pioneered techniques like human factors engineering in an effort to achieve high reliability in perioperative care. Researchers examined 747 adverse anesthesia events at a single institution and found that 43% were preventable. Most preventable events were either respiratory complications or patient injuries, and they were largely due to systems issues rather than individual clinician performance.