Effect of videotape feedback on anaesthetists' performance while managing simulated anaesthetic crises: a multicentre study.

The aim of this study was to examine the performance of anaesthetists while managing simulated anaesthetic crises and to see whether their performance was improved by reviewing their own performances recorded on videotape. Thirty-two subjects from four hospitals were allocated randomly to one of two groups, with each subject completing five simulations in a single session. Individuals in the first group completed five simulations with only a short discussion between each simulation. Those in the second group were allowed to review their own performance on videotape between each of the simulations. Performance was measured by both 'time to solve the problem' and mental workload, using anaesthetic chart error as a secondary task. Those trainees exposed to videotape feedback had a shorter median 'time to solve' and a smaller decrease in chart error when compared to those not exposed to video feedback. However, the differences were not statistically significant, confirming the difficulties encountered by other groups in designing valid tests of the performance of anaesthetists.

Errors on anaesthetic record charts as a measure of anaesthetic performance during simulated critical incidents.

We have measured the performance of 10 trainee anaesthetists during a single simulated anaesthetic during which there was a complex critical incident. Errors in the recording on the anaesthetic charts of the "patient's" oxygen saturation, heart rate, systolic and diastolic arterial pressures and end-tidal carbon dioxide concentrations were used as a measure of mental workload and hence performance. The critical incident was designed to be stressful and contained, in sequence, episodes of hypotension, arrhythmia and bronchospasm. Chart recording errors increased markedly during the critical incident (P < 0.01) and decreased subsequently when the "patient" had stabilized. More than 22% of the values charted during the simulation were in error by more than 25% of the real value, and errors in excess of 100% of the actual value were recorded. There was no evidence of a tendency to consistently underestimate the magnitude of abnormal values. This method is appropriate for assessing the performance of groups of anaesthetists during simulated critical incidents. It also raises questions on the accuracy of anaesthetic record charts when recording critical incidents.

What brings intentions to mind? An in situ study of prospective memory.

In a naturalistic study, we aimed to uncover the relationship between thinking about and remembering intentions. Electronic badges allowed us to track the activities of subjects within their work environment. Over two weeks, subjects were asked to respond using a button on their badges (1) every two hours (Time task); (2) whenever they were in a particular room (Place task). In addition, whenever they thought about the task, they were asked to indicate this with their badges. Although subjects thought about the Time task more, they forgot to respond more often than in the Place task. In the Time task, there was a marked absence of thoughts about the task following successful remembering. When subjects remembered the Place task, thoughts increased with proximity to the target location. In both tasks, thoughts about intentions occurred more in places such as stairwells than in locations where people tended to settle. On the basis of these findings, possible mechanisms for prospective memory are discussed.

Toward the paperless hospital?

This report describes an ethnographic study of document use by anaesthetists. In doing so, it focuses on the role of the preoperative risk assessment form as used in anaesthetic practice at a cardiothoracic hospital, and considers what would be the advantages and disadvantages of shifting the paper into the electronic form. Evidence from this case study is used to comment on how the practical use of documents by medical professionals can be fundamentally at odds with how the organization at large would like to use them. We argue that hospital trusts need to take into account this practical perspective in order to build effective, on-line document systems.