Over the past 50 years, anesthesia has made remarkable progress in terms of quality and patient safety. A SFAR-Inserm survey showed a tenfold decrease in mortality during anesthesia between 1980 and 2000.
Critical situations in anesthesia are rare, but when they do occur, it is essential to detect and manage them quickly. Detecting these situations requires situational awareness, and recovery maneuvers rely on various non-technical skills such as leadership, teamwork, effective communication, and effective workload management.
Crisis Management and Cognitive Aids in Anesthesia
In anesthesia and intensive care, critical situations can take many forms: intraoperative hypotension, intraoperative hypoxemia, patients who cannot be intubated or oxygenated, cardiac arrest during anesthesia induction, etc.
Although some of these situations may occur frequently, they can cause significant stress and sometimes compromise the patient's functional or vital prognosis.
Due to their unusual nature, critical situations in the operating room or intensive care unit require mastery of crisis resource management skills: the ability to analyze the situation, mobilize knowledge and resources, and apply individual technical skills while coping with stress, human cognitive functioning, and the challenges of teamwork. However, in emergency situations, time and cognitive abilities are often limited by stress, a very high mental workload, and potentially increased operational complexity. Mentally recalling the list of actions to take can be difficult and inefficient; certain cognitive biases, such as tunnel vision (fixation error) or confirmation bias, can distort our awareness of the situation. Effective crisis management relies on several principles that can already be implemented and mastered in routine situations. These principles are those of CRM, or Crew Resource Management, developed by NASA, among others. CRM has been adapted to medicine, notably by the anesthesiologist David Gaba, and translated as Crisis Resource Management. CRM is based on several principles. The implementation of cognitive aids and early intervention are examples.
A fundamental element of Crew Resource Management, the use of cognitive aids must become second nature for healthcare professionals in the modern medicine of tomorrow. Whether dealing with risks in aviation, firefighting, or military operations, cognitive aids—also known as “reminders,” “memory aids,” or “emergency procedures”—are essential.
Cognitive aids consist of structured, step-by-step information, provided as close to the event as possible, designed to improve the performance of the medical and paramedical team by guiding decision-making, outlining the sequence of actions, and preventing steps from being overlooked. They can be developed for routine or crisis situations in various formats (cognitive aids, emergency sheets, checklists) and on various media (paper or digital).* In concrete terms, cognitive aids are tools created to guide users in carrying out one or more tasks. Their main objectives are to reduce the risk of errors and increase the speed of task execution. Cognitive aids allow for the standardization of processes to avoid oversights and ensure that no step is omitted. To this end, they are designed to be used during the performance of these tasks.
Most often, they consist of a list of specific tasks that help healthcare professionals recall the various stages of complex care and apply their knowledge appropriately in an emergency situation.
To maximize their effectiveness, cognitive aids are designed to be a team tool that requires a solid understanding and mastery, particularly through their use during team crisis simulation exercises.*
With the primary goal of reducing the risk of error, the SFAR is actively involved in this initiative, providing fact sheets on its website regarding the management of critical situations in anesthesia and intensive care.
Stanford University and Harvard University were pioneers in the development of cognitive aids in anesthesia. Here are some visuals and links to inspire you.
Australian anesthesiologist David BORSHOFF, whom we had the honor of featuring in Patient Safety Report No. 12, was also the creator of the ACM—Anesthesia Crisis Manual—which the European Society of Anesthesiology and Intensive Care makes available on its website
Anesthesiologist Jean Christophe CEJKA was also one of the first to digitize and make cognitive aids interactive using the MAX tool developed by MEDAE.
Finally, it is worth noting the recent efforts of the French Society of Anesthesia and Intensive Care in this area, including the publication of fact sheets on its website regarding the management of critical situations in anesthesia and intensive care, as well as its collaboration with Human Factors in Healthcare to develop professional practice guidelines focused on human factors in crisis situations.
SafeTeam Academy and Crisis Management in Anesthesia
SafeTeam Academy has developed a new e-learning course for anesthesiologists and nurse anesthetists, titled "Managing Critical Situations in the Operating Room," which qualifies for Continuing Professional Development (CPD) credit.
Through immersive video case studies, the course addresses very specific anesthesia scenarios, allowing learners to practice crisis management:
- Intraoperative arterial hypotension under general anesthesia
- Intraoperative hypoxemia under general anesthesia
- The patient cannot be intubated or given oxygen
- Cardiac arrest during induction of anesthesia.
CRM in general, and the use of cognitive aids in particular, are integral to our approach and are included in most of our training courses, especially the one on crisis management, for which you can receive certification.
Log in to your mondpc.fr account and search for the organization 9827 ASN ANESTHESIA SAFETY NETWORK to learn about our CPD (Continuing Professional Development) program on managing critical situations in the operating room.
This new training program offers participants the opportunity to develop their soft skills, learn about crisis resource management, and enhance their leadership abilities.
If you’d like to help improve the reliability of patient care, SafeTeam Academy training courses are for you! To learn more about our Continuing Professional Development (CPD) activities, please contact us at contact@safeteam.academy. *Anesthesia & Resuscitation, Volume 6, French Society of Anesthesia and Resuscitation *https://sfar.org/espace-professionel-anesthesiste-reanimateur/outils-professionnels/boite-a-outils/aides-cognitives-en-anesthesie-reanimation/
