Anaesthesia and patient safety

Volume
37
Spring 09
CONTENT
EDITOR: IAIN MOPPETT
2 - 10
»» Highlights of Euroanaesthesia 2009
»» Integration of the FEEA within ESA:
CEEA a new Committee devoted
to CME
Anaesthesia and patient safety
»» Anaesthesiology and Emergency Medicine in Europe
»» Intensive Care Medicine in Europe
and its Relationship to
Anaesthesiology
»» Euroanaesthesia 2009 Milan
- ESA General Assembly
»» Italian Earthquake
»» A trip to Malta
»» Anaesthesiology in the 21st
century – How far have we come?
»» News from the World Federation of
Societies of Anaesthesiologists
(WFSA)
11 - 20
»» Safe Surgery Saves Lives Initiative
»» What do users think about
ESA website?
»» President honoured by Dutch
Association of Nurse Anesthetists
»» Abstracts for Euroanaesthesia 2009
»» Book review - Crisis
Management in Acute Care Settings
»» Future Anaesthesia Meetings
Copyright 2009
The European Society of Anaesthesiology a.i.s.b.l.
(ESA) No part of this Newsletter may be reproduced
without prior permission. The views expressed in
this Newsletter are not necessairly those of the ESA.
Where identified, the opinions are those of the author.
Otherwise the views expressed are those of the
Editor(s). The ESA cannot be responsible for the
statements or views of the contributors.
Printed on recycled paper to save the environment
Anaesthesia and anaesthetists have always
been concerned with patient safety. This role
is embedded in the constitution of some of
the national European anaesthesia societies.
Patient safety is also one of the aims of the
ESA.
‘To promote improvements in safety and
quality of care of patients who are under
the care of anaesthesiologists inside and
outside the operating room.’
This issue of the newsletter highlights the
various ways in which anaesthesia can
influence and enhance patient safety both
inside and outside the operating room.
There are many facets to patient safety, but
knowledge, processes and behaviour are key
components.
Education
At an individual level education and training
of anaesthetists must play an important role.
Philippe Scherpereel and other colleagues set
up the Foundation for European Education
in Anaesthesiology over 20 years ago with
the aim of providing continuing medical
education in Anaesthesiology, initially just
in Europe but now worldwide. This has been
a hugely successful endeavour, and the ESA
is delighted to be able to carry on this work
following the merger of the FEEA and the
ESA. Konstantin Lebedinski, the ESA website
editor, is keen to broaden the educational role
of the website in response to members’ views.
E-learning may not be to everyone’s taste, but
by offering a wide selection of educational
resources, the ESA is attempting to reach as
wide an audience as possible.
The Annual Congress is of course a major
educational event. Euroanaesthesia 2009
looks set to be a rich mix of broad based
continuing medical education, cutting edge
science and specialty based updates. For
those particularly interested in patient safety
there is a stand-alone post-graduate course
running before the Congress itself.
Safe processes
The processes involved in the provision of
safe health care have been receiving more
attention recently. Although it is easy to
assume that resources are the main issue, work
from the WHO and the WFSA would suggest
that there is much more that can be done to
improve the way we all work. The Safe Surgery
Saves Lives programme and Global Oximetry
project are two examples highlighted in this
issue of the newsletter, where anaesthesia is
absolutely central to delivery of safe healthcare.
Behaviour
Ultimately anaesthesia is delivered as part
of a team. How we behave as part of these
teams can have a huge impact on the outcome
for patients. There is an expanding body of
literature about this topic, but relatively
little directly related to acute care. One book
which claims to address all relevant issues
of error prevention and safe practice in the
acute and emergency healthcare setting is
reviewed in this issue of the newsletter. It
is for readers to decide whether it lives up to
its billing.
The ESA looks forward to seeing you
in Milan. II
The European Diploma is continuing to
expand and Malta has been added to the
list of countries now using the exam as
their formal assessment for trainees. The
diplomates are awarded their diploma at the
Annual Congress, which is always a proud
moment for them, their families and the ESA.
They will no doubt appreciate your support at
the ceremony.
Page 1
Highlights of Euroanaesthesia 2009
Euroanaesthesia will soon be here. There
are many reasons why people come to
the ESA Annual Congress – networking,
new developments, the trade exhibition, education even the scenery. The
Scientific Programme is excellent again
this year, and delegates will be spoilt for
choice. Looking through the preliminary
programme, the Congress will once again
have the inevitable problem of parallel
sessions which people want to attend.
Patient Safety
For those who wish to follow-up some of
the themes in this issue of the newsletter, there are plenty of sessions around
patient safety: wrong side, wrong site
(Saturday lunchtime) preventing mistakes
in obstetric anaesthesia (Saturday
afternoon), trauma management in the
emergency room (how to avoid lethal
mistakes), Safety at the sharp end
(Monday afternoon), Keeping safe. How to
avoid being sued in… (Monday afternoon)
Evidence-based Anaesthesia
Those interested in the process and
outcome of research are well served
too. The British Journal of Anaesthesia is sponsoring two symposia on the
research process, and there are sessions
on recent evidence for interventions in
anaesthesia & intensive care (Saturday
afternoon), evidence based practice
(Saturday afternoon), evidence into
practice (Monday morning) and latebreaking Clinical Trials - how & why they’ll
influence your practice – a symposium
organised by the International Anesthesia Research Society (IARS).
Hands-on
As in previous years, several workshops
are available, though for limited numbers
of participants, so if you want to get your
hands dirty with difficult airways
(Saturday morning or afternoon),
simulated critical events (Saturday
afternoon), regional anaesthesia
(Saturday afternoon), or echocardiography (Sunday morning or afternoon) there
is something for you. This only touches on
a handful of the sessions on offer – each of
the Subcommittees has produced its own
program of symposia and refresher course
lectures. There should be something for
everyone.
Networking
The National Organising Committee has
not neglected the social side of the
meeting. The networking evening will
be a Renaissance Evening at the beautiful
grounds of the main state university of
Milan, Università degli Studi di Milano,
Sunday 7th June 19.00-23.00. With
dancers, jugglers and musicians, and not
to mention several hundred European
anaesthesiologists, it should be an unforgettable event. II
Integration of the FEEA within ESA: CEEA a new Committee
devoted to CME
Philippe SCHERPEREEL, Chairperson of the interim CEEA Committee
The various committees of the ESA can
sometime appear somewhat bewildering.
Philippe Scherpereel provides the Newsletter with a guide to the newly named CEEA.
The
FEEA,
Fondation
Européenne
d’Enseignement en Anesthésiologie, Foundation for European Education in Anaesthesiology, was officially founded on May 28,
1986 by Prof. Johan Spierdijk, Leiden, The
Netherlands, Prof. Philippe Scherpereel, Lille,
France, Prof. Georges Rolly, Gent, Belgium
and Prof. Maurice Lamy, Liège, Belgium.
A wide network for CME
The aim of the FEEA to provide Continuing
Medical Education (CME) in Anaesthesiology,
initially within the European Community,
was extended progressively to the countries
of the European Union and to the countries
of Eastern Europe. Associated centres have
been established in South and Central
America (since 1995), in Africa (since 2004)
and starting in 2006 in Asia. Last year, more
than 6,000 anaesthesiologists attended the
courses in nearly 100 Regional Centres (RC)
worldwide.
Page 2
Merger to form the CEEA
After preliminary talks, the process of merger
between the FEEA and the ESA was achieved
successfully at the end of 2008. On January
1st, 2009, FEEA became the CEEA, an ESA
Committee, governed by an ESA policy. This
policy and explanations related to the activities and management of CEEA can be found
on the ESA website. The former FEEA Board
is acting as interim CEEA until June 2009,
when the chairperson and six CEEA members
will be elected during the first CEEA General
Assembly in Milan during the Euroanaesthesia
Congress.
pain management. In the countries where a
CME credit point system exists, the courses
are accredited with a mutual recognition
by EACME. The courses usually constitute a
residential seminar, limited to around 50
participants. Over three days a variety of
formats are used - lectures, panel discussions, clinical cases, workshops, hands on –
creating as interactive process as possible.
Direct and friendly contact between the
teachers and the attendees, throughout the
day, is the rule.
Regional centres
The CEEA is based on a network of RC,
managed by a Course Director, appointed by
the CEEA, and a local Scientific Committee.
The CEEA courses are organised in agreement
with the National Societies and the academic
authorities in anaesthesiology. The RC are
completely autonomous from pedagogical and
financial points of view. Their only obligation is to respect the format of the courses.
The programme constitutes a cycle of six
courses, covering the whole area of anaesthesia, intensive care, emergency medicine and
Hands on in Vietnam
Integration of the FEEA within ESA: CEEA a new Committee
devoted to CME
Philippe SCHERPEREEL, Chairperson of the interim CEEA Committee
Courses are given in the language of the
country by local teachers, chosen more for
their competency than their titles, and
sometimes guest speakers. Speakers act on a
voluntary basis: they are not paid for their
lectures but may be reimbursed of their travel
expenses when necessary. An evaluation of
teachers by attendees and participants, by
multiple choice questions on the EDA model
or other methods is mandatory. A hand book
which combines all the texts of the lecturers
is provided to the participants before the
course. Centres in France and Spain have also
published books on pharmacology and physiology. These are considered to be a prerequisite for the course. Many centres publish
the courses, texts and slides, on the website
www.euroviane.net (European virtual anaesthesia) which is completely free of access.
Currently, more than 1,000 slide shows
are available on the website, in various
languages, and permanently updated.
Improvements of the website are expected to
make it more interactive with problem based
learning, clinical cases, self assessment….
The list could go on.
A continuous cycle
A certificate of attendance is delivered to
the participants after each course. A diploma
attesting participation in all six courses
is awarded for the completion of the cycle.
A new cycle must be restarted immediately
because CME is a long-life process and six
years seems the most appropriate interval to
renew the knowledge.
The future
Philippe SCHERPEREEL,
Chairperson of the interim CEEA Committee
CEEA Programme: Six courses
INTERIM CEEA
1.
2.
3.
4.
5.
6.
Chair : Philippe SCHERPEREEL
Respiratory and thorax
Cardiovascular
Intensive care, emergency medicine,
blood and transfusion
Mother and child
Neurology, regional anaesthesia,
pain management
Anaesthesia according to the patient
and the type of surgery
Members :
Carmen GOMAR
Maurice LAMY
Annick STEIB
Zeev GOLDIK
Jürgen SCHÜTTLER
Hugo VAN AKEN
In the new structure, nothing will change
for the centres. The European centres will be
supported by the ESA and the extra-European
centres by the World Federation of Societies
of Anaesthesiologists (WFSA). All the RC
will be managed by the ESA Headquarters in
Brussels providing the ESA with not only a
tool for CME in Europe but also an opening on
the world.The merger with the ESA will provide
to the former FEEA a frame to its exponential
development and to the ESA a complementary tool for education in the field of CME
not only in Europe but a positive influence
worldwide.A complete list of the Regional
Centres and their Directors, an agenda of
the courses worldwide and much more information may be found on the ESA website:
http://www.euroanesthesia.org/sitecore/
cont ent /A b ou t _ t he _ E S A/ E S A _ C ommittees/Commit tee%20for %20European%20
Education%20in%20Anaesthesiology.aspx II
Course attendees in Pakistan
Page 3
CEEA
organises Refresher Courses in Anaesthesiology
Continuing medical
education to improve your
professional practice
Because anaesthesiology is a lifelong learning, the
CEEA helps you to raise your knowledge by
organising a cycle of six courses covering all
aspects of the speciality.
The CEEA courses are a unique opportunity to
hear, meet and share your experiences in the field.
We believe that the most successful approach to
learning is to build relationship with colleagues and
qualified speakers, creating a forum for learning
and reflection, and to focus on key topics.
The CEEA courses are held all over the year in
more than a hundred independant centres across
the world. Each course lasts for three days and is
limited to 50 participants. Complete the courses at
your own rhythm, in the language of the country
and in the order you prefer.
Anaesthesiology and Emergency Medicine in Europe
Johannes Th. A. Knape, President of the ESA and Eduardo de Robertis, University of Napoli Federico II, Italy
Doctors of various specialities have the
clinical skill, competencies and interest
to deal with a wide variety of patients
presenting with medical emergencies.
Trauma patients, patients suffering from
acute heart failure, patients presenting with symptoms due to anaphylaxis or
acute pulmonary failure all have one aspect
in common: if they do not have access to
immediate care they may die or suffer
irreversible disability.
The importance of early diagnosis, treatment
and management of patients with acute and
urgent, life threatening signs and symptoms
has been recognised widely. An interesting
debate has been going on between various
European stake holders and in various contexts
for some time about how to offer high quality
emergency medicine (EM) services to as many
patients as possible in any place and at any
moment in Europe. The value of a primary
specialty in EM is included in this discussion.
However, this debate is often confusing due
to many misconceptions, false assumptions
and inconsistent definitions.
What’s in a name?
Particular confusion is caused by the overlap
of the conceptions of “emergency”, “urgency”
and “acute”. It is of note that the concept of
urgent (‘endangering vital functions and/or
life threatening”) is recognised by all parties
to be an integral component of emergency
medicine.
The risk of a too wide or vague EM definition is that different clinical situations are
included under the same umbrella: emergency
situations (which can abruptly deteriorate
and require immediate (minutes) intervention to avoid death or disability) and disease
specific areas of medicine where only initial
care is needed for the acutely ill patient.
There is general agreement that there is no
need for a new specialty of acute medicine.
Acute medicine is an integral part of the
practice of every medical specialty. This
clearly holds true for general surgery but also
for dermatology.
ER for the EU?
Many in favour of a specialty of Emergency
Medicine (as seen in many popular television
series) are inspired by the specialty of EM
in the USA. However, the American healthcare system is very different to many parts
of Europe. In the USA emergency medicine
essentially is acute medicine for the 45
million Americans without any, and many
more Americans without sufficient medical
insurance.
Currently in Europe the primary specialty
of Emergency Medicine (EM) is listed in the
“Doctors’ Directive” 2006/100/EC, in 9 EU
member states out of 27.
A central role for the
anaesthesiologist
Anaesthesiology in Europe is a medical
specialism with defined areas of expertise.
These include peri-operative anaesthesia
care, intensive care medicine and resuscitation, emergency medicine, and pain medicine.
The management of emergency situations
where patients are vitally endangered is so
strongly aligned with the skills and expertise
of anaesthesiologists in their work in the
operating room that anaesthesiological
expertise in emergency situations has been
recognised in many countries to be integral
part of the responsibilities of anaesthesiologists. Currently, both in countries where
emergency medicine is recognised as an
independent specialty and in countries where
it is not, anaesthesiologists are members if
not leaders of emergency teams, often cited
as the best people to manage extremely
difficult emergencies. Due to their role as
leaders in the operating room environment
anaesthesiologists at the same time are well
placed to co-ordinate activities of other care
providers in emergency situations.
Should Emergency Medicine be
a primary specialty?
The European Society of Emergency Medicine
(EuSEM) has proposed the institution of
a Multidisciplinary Joint Committee on
Emergency Medicine (MJC-EM) to harmonise
training in EM and to develop a European
Curriculum for Emergency Medicine. A second
goal of EuSEM is to prepare for a primary
specialty of EM.
The European Board of Anaesthesiology (EBA,
part of UEMS) is convinced that the quality
of medical care in Europe is not necessarily
served by applying for and installing more
and more medical specialties in general.
The European Board of Anaesthesiology has
identified pros and cons with regard to a
primary specialty of Emergency Medicine in
Europe.
In the EBA there is general agreement that
training in emergency medicine should be
harmonised in order to improve the quality of
care. The EBA emphasises the need to focus
on quality and safety, on decreasing resources
and on increasing demand: “do more with
less”, also in relation to the current financial
crisis.
For certain areas in the field of medicine such
as emergency medicine and intensive care
intensive communication and a multidisciplinary approach with respect for each other’s
specific expertise will be more beneficial for
the quality of care than endlessly expanding
the number of specialisms (and kingdoms...).
The EBA is convinced that the practice of EM
would be served best by adopting a multidisciplinary approach by specialists with special
competencies. This is definitely a question of
exclusivity for medical specialties.
Lessons from history
Intensive care medicine (see the accompanying article by Hugo Van Aken) has faced
parallel issues. Like ICM, wide variations
exist in the definition and organisation of
EM care, in the competence of doctors, in
financial resources, in demand, in availability
and in quality of care in the various countries
in Europe. This diversity has increased
considerably following the recent expansion
of the European Union. The EBA is convinced
that geographical reasons, resources and the
existing structure of health care for country
A demand a different approach to provide first
class emergence medicine care than will be
the case in country B. Therefore harmonisation of EM quality of care throughout Europe
is a challenge. The EBA believes that this is
what the Multidisciplinary Joint Committee of
Emergency Medicine should aim for.
Moving forward together?
The European Society of Anaesthesiology
realises that emergency medicine knowledge
and skills are an integral part of an important
but not exclusive area of expertise of anaesthesiology. This is reflected for instance in the
scientific programme of the Euroanaesthesia
congresses, but also in the teaching courses
of the European Committee of Education of
Anaesthesiology (CEEA, the former FEEA).
The ESA aims to be, and to remain in, close
contact with the EuSEM, realising that there
are different routes to the practice of EM
throughout Europe. A primary specialty in
EM may be a reasonable solution in some
countries, but not in many others. ESA is proud
to contribute to high quality of education and
research in EM. The result should be improvement in quality of care for all patients in all
European countries no matter the route by
which this is achieved. II
Page 5
Intensive Care Medicine in Europe and its Relationship to
Anaesthesiology
Hugo Van Aken, Chairperson of the NASC Committee
The status of intensive care medicine
varies at national level throughout Europe.
Hugo Van Aken, the chair of the National
Anaesthesia Societies Committee, has
provided the Newsletter with a guide to the
somewhat obscure processes that define
a professional specialty, with particular
relevance to Intensive Care Medicine.
Intensive Care Medicine (ICM) is an independent speciality in only one of the European
member states, Spain. In most European
countries, Intensive Care Medicine can be
obtained as a ‘particular competence’ with
a common training programme for specialists with Board certification in a variety of
base disciplines: anaesthesiology, cardiac
surgery, cardiology, internal medicine,
neurology, neurosurgery, paediatrics, respiratory medicine, general surgery. A ‘particular competence’ is an area of expertise in
addition to a primary speciality, where extra
expertise outside the domain of the specific
speciality is required to provide high quality
patient care by multidisciplinary input from
doctors from various medical specialities.
EU Directives
The European Directive on recognition
of professional qualifications (Directive
2005/36/EC of the European Parliament)
does not identify ICM as a primary medical
speciality. The European Union requires
that, to become a specialty, it must be
recognised in at least 2/5th of the Member
States and at the same time, by a particular
majority (a weighted vote that is determined
by the population of each country and other
factors and giving what is called a ‘qualified
majority’) in a committee on Qualification of
the European Commission. This applies to all
protected professions not only the medical
profession. Furthermore, to create a Specialist Section for Intensive Care Medicine
within the European Union of Medical Specialists (UEMS), ICM has to be recognised as an
independent speciality by more than one third
of the EU member states and must be registered in the Official Journal of the European
Commission (Medical Directives).
These requirements for a primary speciality
are not fulfilled for Intensive Care Medicine.
Therefore the aim should be the incorporation of Intensive Care Medicine as a PARTICULAR COMPETENCE in the European Directive
2005/36/EC of the European Parliament and
of the Council on the recognition of professional qualifications.
Page 6
This terminology is consistent with all forms
of training based on acquisition of competencies.
A brief history of Intensive Care
Medicine training
Intensive Care Medicine was the first discipline in Europe to develop a multidisciplinary
training programme based on the acquisition
of competencies – clearly defined sets of
knowledge, skills, attitudes and behaviours
which together define the basic abilities
of an intensivist. The CoBaTrICE project1
(Competency-Based Training in Intensive
Care in Europe) and training programme
(www.cobatrice.org), supported by a grant
from the European Community’s Leonardo
Programme, undertook an international
survey of training in adult intensive care
medicine2. Using consensus techniques, this
project defined the core (minimum) competencies required of a specialist in adult intensive
care medicine3. A survey of ICM training
programmes in different EU member states
found that the median duration of training is
24 months2. The 102 competencies defined
by CoBaTrICE provide a sound basis for identifying intensive care medicine within the
Directive as a particular competence.
Does it matter?
An important additional factor to consider
is how changes to the status of ICM might
affect the quality of patient care. Current
evidence suggests that patient outcomes are
better when patients are cared by trained
intensivists. In Europe this can be achieved
by facilitating the acquisition of harmonised
common competencies in ICM by trainees
from a wide variety of primary speciality
training programmes. This may also have the
added benefit of optimising the staffing of
intensive care units.
Moving forward
This request has been approved by the
European Board of ICM and further ratified at
a meeting of the presidents (or secretaries)
of the sections of anaesthesiology, cardiac
surgery, cardiology, internal medicine,
neurology, neurosurgery, paediatrics, respiratory medicine, general surgery and Board
Members of the European Board of Intensive
Care Medicine on April 16, 2008. Following
presentation to the UEMS speciality Sections
and Boards on April 17, 2008, it was then
presented to the UEMS Council on April 18,
2008, where it received unanimous approval.
The next step is to obtain explicit support
from the national representatives of the
involved European Commission and Parliament through national training organisations
in ICM. This would provide support for the
notion that the European Parliament and
Council should include ICM as a Particular
Competence in the Directives 2005/36/EC of
the European Parliament and of the Council
on the recognition of professional qualifications.
Problems to solve
In December 2008 we had the opportunity of
meeting the responsible persons in the EU
headquarters in Brussels and to discuss our
request. We were told that in general it was
not mandatory to go this way, because for
those disciplines that are not mentioned in
annex 5, article 10, the “general system for
recognition of evidence of training” is valid.
During the discussions it was made clear
that it is important for the Committee to
be aware of cases where doctors recognised
in Intensive Care Medicine in one particular
country have problems getting recognition in
other EU countries. In the meantime, we have
already received information from one doctor
in the Netherlands who has problems with his
recognition in Intensive Care Medicine and
also from a colleague in the United Kingdom
with similar problems. If you should know
of somebody with similar problems please
inform me as soon as possible. It would help
us reaching our goal.II
1. www.cobatrice.org
2. Barrett, H., Bion J.F. An international
survey of training in adult intensive care
medicine. Intensive Care Med (2005)
31:553-561
3. The CoBaTrICE Collaboration. Development of core competencies for an international training programme in intensive
care medicine. , Intensive Care Med
(2006) 32:1371-1383
Euroanaesthesia 2009 Milan - ESA General Assembly
On behalf of the Board of Directors, I am pleased to invite ESA
members to the Annual General Assembly of the European
Society of Anaesthesiology which will be held in room Red
2 at the Milano Convention Centre, Milan, Italy on Monday 8
June 2009 from 12:15 to 13:30.
Active, Affiliate, Honorary, Retired and Trainee Personal Members
and one representative of each Member Society may attend, but
only Active Personal Members may vote. There are no proxy votes.
The minutes of the last General Assembly held in Copenhagen,
Denmark, are published in volume 34 (Summer 2008) of the ESA
Newsletter. The ESA Newsletter and By-Laws are both available
on the ESA website.
5. Treasurer’s report
6. Approval of the 2008 Annual Accounts and 2009 budget
7. Relieving the Board of Directors and Auditors of their
liability for the 2008 accounts
8. By-Laws
9. Specialist Societies membership fee
10. Commercial entity owned by the ESA
11. Board of directors election results
12. Nominations Committee elections
13. European Diploma in Anaesthesiology
14. Council Activity Report
15. Any other business
16. Date and place of the next meeting
I look forward to meeting you in Milan. II
The agenda of the 2009 General Assembly is:
1.
2.
3.
4.
Welcome
Approval of the minutes of the 2008 General Assembly
President’s report
Secretary’s report
Yours sincerely,
Eberhard Kochs
ESA Secretary
Italian Earthquake
Dear members
Milan, Italy, will be the host of Euroanaesthesia 2009 within a few weeks and every
effort is made both by the ESA secretariat
and especially by our Italian friends to
make the 2009 Euroanaesthesia meeting
a great success. Italy and the rest of the
world were shocked by the devastation, the
number of casualties and often severely
wounded victims which resulted from the
earth quake which hit L‘Aquila, 95 km from
Rome on the 6th of April 2009.
The suffering of tens of thousands of
homeless Italians in fear of damage from
further after shocks was broadcast widely
in the news, made a great impression to
all of us and made us all, as Europeans,
feel the need to stand united in trying to
relieve the suffering. The European Anaesthesia community expresses its condolences to the families of the deceased victims
and offers its sympathy and understanding
to the affected Italians and their families
at this time. By displaying our knowledge
and expertise in the field of emergency
medicine and medical support to acutely
injured patients and to those who are in
vital danger, the European Anaesthesia Community, represen-ted by ESA,
will contribute to better patient care for
victims of disasters such as the earth quake
which struck Italy recently.
These days we feel very close to our
Italian friends: you are in our minds.
Hans Knape, ESA President
A trip to Malta
Zeev Goldik, Chairperson of the Examinations Committee
I visited Malta with the purpose of establishing an agreement for adoption of the
European Diploma Examination (Part I MCQ
and Part II Oral final exam) as the official
mandatory examination in Malta. It is an
honour to be able to visit other countries
as part of my work with the EDA. Every
country is different, with much to offer.
Dr. Kovac likes football and from him I learnt
that the Maltese population (around 405,000
inhabitants) is divided into 2 main groups:
fans of Italian and fans of English football.
Club success is celebrated very actively with
flags on the streets.
At my arrival to the Airport in Malta, Dr.
Blazej Kovac was waiting for me. He came to
Malta 12 years ago from Slovakia where he
lives with his family. His children grew up
in Malta and like the other immigrants from
Eastern European countries Dr. Kovac adapted
perfectly to his new country of residence.
Coming out of the airport, we drove on the
left. Malta is an ex-British Colony that gained
its independence in 1964. The country is a
group of islands situated in the Mediterranean Sea, 98 km south of Sicily, Italy.
A brief history
Web URL: http://www.visitmalta.com
Page 7
A trip to Malta
Zeev Goldik, Chairperson of the Examinations Committee
Malta joined the European Union in year 2004,
and the Euro zone in 2008. In addition it is
part of the Commonwealth.
I was invited to Malta by the officers of the
AAM (Association of Anaesthesiologists of
Malta) and the Anaesthesiology Training
Committee: Dr. Carmel Abela (President);
Dr. Mario Zerafa (Vice President); Dr. Simon
Paris (Treasurer) Dr. Zarb Adami (Chairman
Department of Anaesthesia Mater Dei
Hospital) and Dr. Andrew Aquilina (Training
Coordinator). I had also the honour of acting
as external examiner in a 2 days assessment
of their residents, and I delivered a Continuing Professional Development (CPD) lecture.
Health services in Malta
In Malta there is one main Public General
Hospital called Mater Dei. This new hospital
started to function just over a year ago after
migrating from the older St Luke’s Hospital.
I was impressed by the new building, the well
equipped operating theatres and Intensive
Care unit, the comfortable facilities for the
anaesthesiologists (one office for every
2 consultants) the updated library, the
meeting rooms and the modern auditorium
where I presented my lecture.
Much credit goes to the Chairman of the
Department of Anaesthesia Intensive Care
and Pain Medicine, Dr. Joseph Zarb Adami,
who, as I was informed, was behind the
successful development of the Anaesthesiology Department and operating theatre and
ITU equipment as well as the brain behind the
successful migration from the old to the new
hospital.
Examinations
As I already mentioned the annual trainee
assessments were timed around my visit so
that I could be the external examiner. One
after the other the residents came in for their
oral exam. First came the 4 and 5th years
residents, the intermediate residents came
after, and last the residents after 1 or 2 years
of residency. In all we assessed 10 residents.
This assessment was held in a room showing
paintings of portraits of some of the pioneers
in anaesthesia in Malta.
Maltese people speak perfect English as well
as their mother language: Maltese. This is a
mix of Semitic and Latin languages which
is a reflection of the multiple cultures that
have influenced this small country over its
long history of existence. This In Training
Assessment was conducted in similar to the
European Diploma Oral vivas with 2 examiners
and using guided questions.
Impressive candidates
I was impressed by the high level of all
candidates. Even the first year residents were
brilliant and I learnt that all of them passed
the EDA part I very early. This is not the
normal situation in most European countries.
On average candidates sitting the European
In Training Assessment during the first
2 years have a pass rate of around 20%.
One of the successful candidates, Dr. Anne
Marie Camilleri Podesta, combined being
a doctor in training with being a harpist. She
was also the granddaughter of one of these
pioneers of Malteses Anaesthesia.
Dr. Podesta was also successful in the EDA part
I during her first year of training. She sat it in
Lisbon where she also participated as invited
guest harpist at a concert of the Portuguese
Philharmonic Orchestra. I watched her playing
harp the night of the assessment in Malta
with the Gukulari Ensemble at a Monastery in
Valletta (the capital city). She and the other
members played Maltese ancient compositions wearing Maltese folkloric dresses.
My visit ended with the ceremony of signing
of the ESA-Maltese agreement. According
to this historical event, Malta adopted the
European Diploma Examination (Written
Part I and Oral Part II) as the official national
mandatory examination in anaesthesia.
This agreement was signed by Dr. Carmel
Abela, President of the Association of Anaesthesiologists of Malta, by myself as Chairman
of Examinations Committee of the ESA and
also signed by the country’s Parliamentary
Secretary of Health, Dr. Joe Cassar in Palazzo
Castellania. II
Adoption of the European Diploma Examination by Malta
From left to right, at the front are: Dr. Carmel Abela,
Dr. Joe Cassar and Zeev Goldik. At the back are: Dr. Mario
Zerafa, Dr. John Cachia, Dr. Mariella Borg-Buontempo,
Dr. Joseph Zarb Adami and Dr. Andrew Aquilina.
Anaesthesiology in the 21st century – How far have we come?
Jannicke Mellin-Olsen, Norway, President of EBA/UEMS
In connection with the 4th International
Baltic Anaesthesia Congress in Riga, Latvia,
December 2008, the EBA (European Section
and Board of Anaesthesiology/UEMS)
organised a seminar focused on education
and the future of our specialty. Below some
issues are highlighted, more are to follow
in the next edition of the ESA Newsletter:
In Latvia, it seems like all important people
are anaesthesiologists, including Member
of the European Parliament, Prof. Georgs
Andrejevs, the mayor of Riga Janis Birks, the
president of the medical association, etc.
Page 8
The influence of the EBA
Nevertheless, our speciality was faced with a
threat from the authorities that the duration
of specialist training was to be reduced to
three years, as there is an increasing shortage
of anaesthesiologists. The good news is that
organisations like the EBA can have some
influence, as can be seen from an e-mail from
Prof. Antonina Sondore some weeks ago:
“The Board of Latvian Association of Anaesthesiologists and Reanimatologists is happy
to inform UEMS EBA that despite the dramatic
financial crisis in our country nothing will be
changed in the training system in our specialty.
The duration of residency will be as before - five
years. We are certain that representatives of the Dept.
of the Postgraduate Professional Education of
the Latvian Health Ministry, who were invited
to attend the seminar, forwarded all the considerations, recommendations and results of the
discussion further, underlying the necessity to
harmonise and coordinate our profession in
Europe on a high level on the basis of five years
training. Thanks UEMS EBA for the coming to Riga with
the aim to help us to prevent going back to
three years of training.”
Anaesthesiology in the 21st century – How far have we come?
Jannicke Mellin-Olsen, Norway, President of EBA/UEMS
Threats to our specialty
Latvia is not the only country facing
manpower shortage problems and efforts by
health authorities to make shortcuts. This
is attempted, either by importing foreign
specialists that do not speak the relevant
language well and may have insufficient
training or – by decreasing the quality and
duration of the training in the country itself.
By EU regulations, if you are a registered
specialist in one EU country, you will be
approved in another. That is one reason why
colleagues in Europe must unite, not only by
sharing theoretical knowledge during our ESA
congresses and in the journal. We must work
together on a political level, and for this, we
have bodies like the EBA.
Where are we going?
Another good example of the cooperation between ESA and EBA is the Fellowship of the European Board, which will be
launched shortly. The Fellowship aims to
ensure that colleagues with a defined level of
competence (often higher than the specialist training in a country requires) are recognised as such. As soon as the formalities are
in place, the Fellowship applications will be
advertised.
An example of current strategy work that was
met with interest was presented by Prof. Eldar
Søreide, the president of the Scandinavian
Society of Anaesthesiology and Intensive
Care Medicine. The SSAI Board is currently
undertaking a questionnaire study to find
out what all Scandinavian colleagues would
like to see happen with our speciality in the
future. By doing that, the SSAI wants to be
an active leader of the development, not a
passive bystander:
Currently, we (the SSAI) cover anaesthesia,
intensive care medicine, pain medicine and
emergency medicine.
•
•
•
•
•
•
Is that what we would like
to see in the future, or
Would we like to limit ourselves?
Do we want formal sub-specialisation
in e.g. cardiothoracic, paediatric,
obstetric, etc – anaesthesia?
Or do we want to see, for instance
emergency medicine as a supra
speciality (many specialities can be
the entry to further training)?
Or rather to develop areas of competence, like we see is happening for
intensive care medicine in Europe
(not a formal speciality, but defined
training on top of a speciality)?
What about nurse anaesthetists?
The SSAI is trying do define its core business
for the future, and to look at strengths and
weaknesses, opportunities and threats with
the models.
This approach was met with interest by other
participants. Are any other societies undertaking similar work?
A vision for the future
Prof. Søreide put forward his vision of what
anaesthesiology is all about:
•
•
•
Anaesthesiologists
have
pioneered
the fields of intensive care medicine,
emergency medicine and pain medicine.
Anaesthesiologists are the ultimate
team leader, life-saver and pain doctor.
Anaesthesiologists should still be in the
lead.
Patient safety
Another field of medicine that anaesthesiologists have pioneered is in patient safety.
Dr. Sven Staender from Switzerland, who
also is the chair of ESA Scientific Programme
Subcommittee 17 presented the ‘Patient
Safety Curricula and the European Patient
Safety Course’.
Patient safety is an important problem in
our increasingly complex health-care system.
This subject is attracting increased attention
through the intervention of influential
partners such as the Institute of Medicine
in the United States and the Ministerial
Committee of the Council of Europe.
The Patient Safety Subcommittee (SC-17)
of the European Society of Anaesthesiology
(ESA) has therefore drawn up proposals as to
how the handling of errors can be integrated
into the undergraduate and postgraduate
training of all health professionals and anaesthesiologist in particular. Training patient
safety must start in the universities or
medical schools. This undergraduate training
should focus on the basic aspects of patient
safety such as definitions and methodologies. The epidemiology and magnitude of the
problem must be rehearsed. The table gives
the recommended content of such training
in patient safety. These contents will also
be expounded during the European Patient
Safety Course (EPSC) that is organised and run
by the Patient Safety Subcommittee (SC-17)
and will be held during the Euroanaesthesia
Congress. II
We have a lot to look forward to!
Professor Georgs Andrejevs, the mayor of Riga Jānis Birks,
Member of the European Parliament and anaesthesiologist
An eager audience, including some dignitaries, from various
anaesthesia societies
Page 9
Anaesthesiology in the 21st century – How far have we come?
Jannicke Mellin-Olsen, Norway, President of EBA/UEMS
European Patient Safety
Course
€ 150.00 per person
(including lunch, soft drinks
and coffee during the day)
Date/Time
The course is 8 hours, split in two
parts before Euroanaesthesia 2009
First part:
Friday, June 5th from 14:00 to 18:00
Second part:
Saturday, June 6th from 08:00 to 12:00
More information:
http://www.europatientsafety.eu/epsc/
Undergraduate training
Postgraduate training
Definitions
• Definitions, magnitude of the
problem, epidemiology (L)
According to the needs of the specialty (anaesthesiology is given as an example here)
Fundamentals
• Error-model (J. Reason),
system failure (L)
• Human limitations (L)
• The role of the teams, hierarchy (L)
• Safety culture (principles of high
reliability organisations) (L)
Analysing the problem
• Reporting systems (L)
• Event-analysis (root-cause,
London-protocol) (PBLD)
Tackling the problem
• Main topics in safety problems:
medication error (prescribing, wrong
drug, wrong site, wrong dose), wrong
side/site procedures, hospital acquired
infections, patient handover (PBLD)
• Open disclosure communication (L; PBLD)
Knowledge about…
• … Risk communication (how to communicate risk with the patients) (L)
• Informed consent (L)
• … Medico-legal aspects (L)
• … Open disclosure (the aftermath of an event)
(L; PBLD)
• … Dealing with the team: the second victim
(L; PBLD)
• … CRM-training (S)
• … Simulation (airway management, CPR etc…) (S)
• … Value of checklists (L; S)
• … Safety standards, guidelines and protocols
• MH-crisis, LA-intoxication, difficult
airway, broncho-laryngospasm, pneumothorax, aspiration, total spinal, awareness,
air embolism, inadvertent intra-arterial
injection, anaphylaxis …) (L; PBLD)
• ... Setting up learning systems
(incident reporting and RCA) (L)
• ... Implementing innovations (PDCA-cycles
(Plan-Do-Cycle-Act)), why we don’t follow
guidelines (L)
L = Lecture; PBLD = Problem based learning discussions; S = Simulation
News from the World Federation of Societies of
Anaesthesiologists (WFSA)
Angela Enright, President of the WFSA and Alan Merry, Chairperson of the WFSA Safety and Quality of Practice Committee
The ESA is pleased to be able to continue
its collaboration with the WFSA and publish
more information about what is happening
with this important organisation. This
article focuses on the work of the Safety
and Quality of Practice Committee, chaired
by Prof Alan Merry of New Zealand. The
goal of the WFSA is to improve the standard
of anaesthesia world-wide. The Safety and
Quality of Practice Committee is contributing to this through several projects.
WFSA Web Site
(www.anaesthesiologists.org)
This has been an important part of improving
communication with member societies. Safety
and Quality of Practice Committee member,
Dr. Nian Chih Hwang, contributes an Alerts
Section which he updates regularly.
Standards
The International Standards for Safe Anaesthesia developed by an independent task
force, endorsed by the WFSA at The Hague,
and published in 1993, have been revised as
part of a WHO Global Challenge, Safe Surgery
Saves Lives.
P a g e 10
Many people assisted with this task,
notably Iain Wilson, Meena Cherian, Olaitan
Soyannwo, Jeff Cooper and John Eichhorn
(who was part of the original task force).
The revised standards were endorsed by the
General Assembly of the WFSA in Cape Town
in March 2008. They can be viewed on the
Website (http://www.anaesthesiologists.org/
en/latest/2008-international-standards-fora-safe-practice-of-anaesthesia.html).
The Executive of WFSA has also endorsed a
standard promoting the interoperability of
anaesthesia equipment, and this too can be
seen on the website (http://www.anaesthesiologists.org/en/latest/interoperability-ofmedical-devices.html).
Global Oximetry Project
This was a collaborative project between
WFSA, AAGBI and GE Healthcare, to provide
low cost pulse oximeters in a package that
included education, collection of data and
agreements with local anaesthesia providers
and healthcare administrators to achieve
long-term sustainable change in practice.
The Global Oximetry (GO) Committee was
initiated from the Safety and Quality of
Practice Committee, with Dr. Gavin Thoms
as our representative and overall Chair.
Sub-projects were undertaken in Uganda, the
Philippines, Vietnam and India. The aim was
for each sub-project to be self-funding. GE
Healthcare donated a total of 58 oximeters,
125 sensors and training materials. They
also provided considerable logistical support
(hosting teleconferences, delivering the
oximeters, providing maintenance etc.). GE
proved to be a great partner in this effort
and we are grateful for their support for this
important effort. We are particularly grateful
for the ongoing commitment of Mark Philips
and Colin Hughes.
The participating anaesthesia professionals have completed logbooks and data was
presented at the World Congress in Cape
Town. A final report is in preparation, to be
followed by peer reviewed publications.
For a variety of reasons, the tripartite
structure was wound up in Cape Town and
the GO project returned to the oversight
of the WFSA Safety and Quality of Practice
Committee. It remains the Committee’s single
most important activity.
News from the World Federation of Societies of
Anaesthesiologists (WFSA)
Angela Enright, President of the WFSA and Alan Merry, Chairperson of the WFSA Safety and Quality of Practice Committee
WHO, Safe Surgery and Pulse
Oximetry
Alan Merry and Iain Wilson have also been
involved in the World Health Organisation
Safe Surgery Saves Lives project (not as
representatives of WFSA) and have been very
gratified to see the development of a universally applicable checklist with considerable
relevance to the promotion of teamwork
in the operating room and support for the
importance of anaesthesia in safe surgery.
This check-list is receiving some high-profile
attention around the world. (More information on this in the Newsletter. See fig2: Table
on p12).
The WHO has now developed a follow-on
initiative to advance the idea of Global
Oximetry. This builds on the work of the WFSA
GO project and involves Alan and Iain and
also several members of the WFSA Executive
committee including Angela Enright, Florian
Nuevo, Gonzalo Barreiro and Rob McDougall.
Working with other members of the WHO
team, specifications for the ideal oximeter
have been developed and an educational
package is being put together.
Applications to be a pilot site in this effort are
available on the WHO website and have been
circulated to WFSA member societies. This is
a very exciting development and should lead
to improved peri-operative patient safety
around the world.
The Virtual Anesthesia Machine
The Virtual Anesthesia Machine is an independent educational project under the direction
of Dr. Sem Lampotang. It is supported by the
Safety and Quality of Practice Committee. A
link to this project is in place from the Safety
and Quality of Practice Committee section of
the WFSA website.
Drug safety
Efforts to promote clearer, more standardised
presentation of information on the labels of
drug ampoules will be an activity of increased
importance for the Safety and Quality of
Practice Committee over the next four years.
Professor Merry would welcome contact if you
have any comments or suggestions or would
like to contribute to any of this Committee’s
activities. II
Crisis Management Manual
We are very grateful to the Australian Patient
Safety Foundation (APSF) for allowing the
Safety and Quality of Practice Committee to
place a link from the WFSA website to the
APSF Crisis Management Manual.
Incident Reporting
Professor Quirino Piacevoli is responsible
for a new project to make incident reporting
available to countries that do not currently
have access to this facility.
Safe Surgery Saves Lives Initiative
Other articles in this issue of the Newsletter have touched on the role of anaesthesia
in promoting patient safety. The World
Health Organisation chose safe surgery
as the topic for its second Global Patient
Safety Challenge. The early results from
pilot sites using the Safe Surgery Save
Lives checklist are now published, and
countries throughout Europe are starting
to adopt the process.
‘There is no single remedy that will improve
surgical safety. It requires reliable completion
of a sequence of necessary steps in care, not
just by the surgeon, but by a team of healthcare professionals working together within a
supportive health system for the benefit of the
patient.’
Data from the WHO suggest that major
complications occur in 3-16% inpatient
procedures, with death or permanent disability rate of around 0.4-0.8%. These figures
apply to industrialised countries. In developing countries the death rate is estimated
to be around 5-10% during major surgery.
At least half of the cases where surgery
caused harm are thought to be preventable.
Anaesthesiologists can all testify to situations were sub-optimal care led to patient
harm. Although individual poor practice does
occur, more commonly there are failures in
the process of care. Anaesthesiologists are
intimately involved with many aspects of the
patients’ surgical journey and initiatives such
as these give the specialty the opportunity
to improve patient care for a vast number of
patients.
The SSSL project was split into four working
groups: Surgical site infection prevention, safe anaesthesia, safe surgical teams,
and measurement of surgical services. The
outcomes from these working groups were 10
objectives and a checklist for use in the perioperative period.
Ten objectives
The ten objectives of the SSSL project are
shown below. Of these 10, only numbers 7
and 8 do not necessarily involve the anaesthesia team. It may be a ‘safe surgery’
project, but the anaesthesia team plays an
important part.
P a g e 11
Safe Surgery Saves Lives Initiative
Objective 1. The team will operate on the correct patient at the correct site.
Objective 2. The team will use methods known to prevent harm from anaesthetic administration, while protecting the patient from pain.
Objective 3. The team will recognise and effectively prepare for life-threatening loss of airway or respiratory function.
Objective 4. The team will recognise and effectively prepare for risk of high blood loss.
Objective 5. The team will avoid inducing an allergic or adverse drug reaction known to be a significant risk to the patient.
Objective 6. The team will consistently use methods known to minimise risk of surgical site infection.
Objective 7. The team will prevent inadvertent retention of sponges or instruments in surgical wounds.
Objective 8. The team will secure and accurately identify all surgical specimens.
Objective 9. The team will effectively communicate and exchange critical patient information for the safe conduct of the operation.
Objective 10. Hospitals and public health systems will establish routine surveillance of surgical capacity, volume and results.
At first sight, the objectives seem to be
so self-evident as to not be necessary in a
checklist. If you believe this is the case, it
may be instructive to discuss with colleagues
how many incidents they are aware of where
patient harm has occurred under one of those
headings.
In parallel with other high-risk industries,
the WHO chose to go down the checklist route
in an attempt to minimise the risk of missing
these objectives.
Safety checks that could be carried out in any
operating theatre environment around the
world were identified. The WHO claim that
three guiding principles were used: simplicity, wide applicability and measurability.
Simplicity meant that an exhaustive checklist
was not produced. There are some aspects
of surgical patient safety that are not on the
checklist. The WHO argument is that it is
better to institute something simple properly,
rather than have a tool that is difficult to use.
The checklist
16/6/08 18:01
1
The checklist was produced
afterPage
widespread
consultation with numerous specialties linked
to surgical care, including anaesthesia, from
across the world.
Checklist only:Layout 1
Wide-applicability was built in to avoid
questions about local resources. Of note,
the only anaesthesia specific equipment
mentioned is pulse oximetry, intravenous
access and appropriate fluids. Capnography, blood pressure, ECG are notable by their
absence. In the developed world we might
take all of these for granted. In the less well
resourced healthcare systems even a pulse
oximeter may be a significant issue.
Measurability was felt to be essential if the
checklist were to be anything more than a
wish list of good intentions. All of the items
on the checklist can be measured and so
can the objectives. Some of the objectives
are rare events (e.g. wrong site surgery) but
surrogate metrics exist for such events.
SURGICAL SAFETY CHECKLIST (FIRST EDITION)
Before induction of anaesthesia
SIGN IN
PATIENT HAS CONFIRMED
• IDENTITY
• SITE
• PROCEDURE
• CONSENT
Before skin incision
TIME OUT
PULSE OXIMETER ON PATIENT AND FUNCTIONING
ANTICIPATED CRITICAL EVENTS
DOES PATIENT HAVE A:
SURGEON REVIEWS: WHAT ARE THE
CRITICAL OR UNEXPECTED STEPS,
OPERATIVE DURATION, ANTICIPATED
BLOOD LOSS?
DIFFICULT AIRWAY/ASPIRATION RISK?
NO
YES, AND EQUIPMENT/ASSISTANCE AVAILABLE
RISK OF >500ML BLOOD LOSS
(7ML/KG IN CHILDREN)?
NO
YES, AND ADEQUATE INTRAVENOUS ACCESS
AND FLUIDS PLANNED
NURSE VERBALLY CONFIRMS WITH THE
TEAM:
THE NAME OF THE PROCEDURE RECORDED
ANAESTHESIA SAFETY CHECK COMPLETED
KNOWN ALLERGY?
NO
YES
SIGN OUT
CONFIRM ALL TEAM MEMBERS HAVE
INTRODUCED THEMSELVES BY NAME AND
ROLE
SURGEON, ANAESTHESIA PROFESSIONAL
AND NURSE VERBALLY CONFIRM
• PATIENT
• SITE
• PROCEDURE
SITE MARKED/NOT APPLICABLE
Before patient leaves operating room
ANAESTHESIA TEAM REVIEWS: ARE THERE
ANY PATIENT-SPECIFIC CONCERNS?
THAT INSTRUMENT, SPONGE AND NEEDLE
COUNTS ARE CORRECT (OR NOT
APPLICABLE)
HOW THE SPECIMEN IS LABELLED
(INCLUDING PATIENT NAME)
WHETHER THERE ARE ANY EQUIPMENT
PROBLEMS TO BE ADDRESSED
SURGEON, ANAESTHESIA PROFESSIONAL
AND NURSE REVIEW THE KEY CONCERNS
FOR RECOVERY AND MANAGEMENT
OF THIS PATIENT
NURSING TEAM REVIEWS: HAS STERILITY
(INCLUDING INDICATOR RESULTS) BEEN
CONFIRMED? ARE THERE EQUIPMENT
ISSUES OR ANY CONCERNS?
HAS ANTIBIOTIC PROPHYLAXIS BEEN GIVEN
WITHIN THE LAST 60 MINUTES?
YES
NOT APPLICABLE
IS ESSENTIAL IMAGING DISPLAYED?
YES
NOT APPLICABLE
THIS CHECKLIST IS NOT INTENDED TO BE COMPREHENSIVE. ADDITIONS AND MODIFICATIONS TO FIT LOCAL PRACTICE ARE ENCOURAGED.
Safe Surgery Saves Lives Initiative checklist (Web URL: http://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Checklist_finalJun08.pdf)
P a g e 12
Safe Surgery Saves Lives Initiative
More bureaucracy or safer
surgery?
The WHO acknowledges that the checklist
includes many actions that are already part of
routine practice in many places. Conversely,
there are few places that undertake all of them
in their entirety. Individual units are encouraged to integrate the checklist process with
their current practice. There are some who
argue that more checklists are not the answer
– if teams are not safe now, then making
them sign another piece of paper is unlikely
to make them safe either. To an extent that
is probably true. But, that misses the point
of the checklist. It is not intended to be a
piece of paper divorced from the reality of the
surgical process. It is the documentation and
prompt for excellence in patient safety.
There is some evidence for the benefit of
the checklist process. The SSSL pilot study,
from 8 worldwide sites , reported a headline
reduction in 30 day mortality from 1.5% to
0.8% and complications from 11% to 7%.
Although there may be scientific criticism of
the study, the mortality reduction is impressive. Certainly it is hard to argue that the
checklist process causes harm.
1. http://www.who.int/patientsafety/
safesurgery/ knowledge_base/
SSSL_Brochure_ finalJun08.pdf
2. Haynes AB, Weiser TG, Berry WR et al.
A surgical safety checklist to reduce
morbidity and mortality in a global
population. New Engl J Med 2009; 360:491-9
Anaesthesiologists in the lead?
The central role of anaesthesiologists in care
of the surgical patient means that as a profession, we can choose to make this process
happen or not. There are flaws in the process,
but unless we have something better, can we
do anything else? II
What do users think about ESA website?
Konstantin Lebedinskiy, ESA Website Editor and member of the Media Committee
The ESA website users’ survey, initiated by
Media Committee following Euroanaesthesia 2008, was carried out from November
1st to December 15th 2008. In total, 587
respondents took part in the survey, out of
around 5500 ESA Members were invited by
e-mail.
Who is the ESA website “average user”? The
majority of the respondents are specialists
(88.9%) between 30 and 60 years old (85.1%)
with more than 10 years of professional
experience (74.4%) and active ESA membership (92.7%). Thus, first of all, our audience
represents present day European anaesthesiology, but not its future!
P a g e 13
What do users think about ESA website?
Konstantin Lebedinskiy, ESA Website Editor and member of the Media Committee
The principal spheres of our respondents’
professional activity are adult anaesthesia
combined with intensive care (193) and both
adult and pediatric anaesthesia (132).
Regarding the ESA website, the most of the
respondents use it monthly (73%) and less
than five times a month (68%). The two most
common purposed for visiting the website
were as would be predicted − education (77%)
and annual congress registration (70%).
Interestingly, almost equal numbers of survey
participants would like to see additional
features on the website such as digests of the
latest literature highlights (72%) and interactive E-learning tools (70%).
A wider perspective
These data may be complemented with statistics from Google Analytics, based on 151,334
visits to www.euroanesthesia.org during
2008. Our website user lives most probably in
the United Kingdom (13,883 visits), Belgium
Not surprisingly, our respondents regularly
use the websites of their National Societies
(75.6%), ASA (47.5%) and ESRA (31.9%). As
to the best anaesthesiological website, nearly
one third of the respondents (32.7%) named
www.euroanesthesia.org, about every fourth
(26.6%) named ASA website, and less than one
fifth (18.3%) − the website of their National
Societies. Certainly, “different websites have
different “best parts” which makes it difficult
to pick an overall best website”, as one of
our respondents wrote. However, 8 participants named as the best one the website of
Société Française d’Anesthésie et de Réanimation (SFAR, www.sfar.org), 5 respondents
voted for the Royal College of Anaesthetists
(RCOA, www.rcoa.ac.uk) and the same number
− for New York School of Regional Anesthesia
(NYSORA, www.nysora.com).
Any comments?
A very interesting part of the results is free
comments, left by one in ten respondents (58
Can we meet the educational
challenge?
What are our capabilities to meet these
educational requirements? Certainly, an
E-textbook, created by leading experts
especially for the Society, fully corresponding to the EDA Exam syllabus and updated
constantly by the authors would be an ideal
solution! But, even if the ESA were to aim for
such a strategic goal, it would take several
years and a lot of effort. More immediately we
need to bear in mind that although lifelong
learning and CME are actually essential things
for senior specialists, E-learning tools are the
only possible way to attract the young professional audience.
We actually have to invent nothing! The
Internet has a lot of excellent educational
resources, and our task is to select appropriate and reliable weblinks. Moreover, there
are a lot of inspiring examples of useful
weblinks lists, including anaesthesiological
ones; for instance, look at MetroHealthAnesthesia page http://metrohealthanesthesia.
com/links.htm. A possible first step is to
elaborate the exact “roadmap”, containing
all the topics of, for example, CEEA (former
FEEA) Course Programme. All of these topics
could be supplied with corresponding items
− problem-oriented websites, relevant pages,
chapters from E-books, lectures presentations, videos, interactive tools, etc. So, we
should just fill all these “boxes” with the best
links available (to tell the truth, this job will
not be simple!).
A possible structure of our future educational
resource may be illustrated by the algorithm
of a data search (see picture on p.15) and
example of a webpage, devoted to a certain
topic in a specific language. An idea of what
this might entail for the English version of
Malignant Hyperthermia is shown opposite.
(12,775), Germany (12,520) or the United
States (10,111), using Internet Explorer
(79.1%), visiting most probably on Monday
and Tuesday. The average number of pages
accessed is 5.23 pages and around 4 minutes
is spent at the site. It should be noted, that
the “Education” page was actually the third
in popularity across the site (24,978 page
views out of in 791,993)! Approximately 30%
of visitors, however, leave our website from
the main page without further exploring its
content. So, we there is much more to do!
P a g e 14
of 587). Some of them are very useful, but
purely technical (some links do not work, font
is too small, etc. − 10 of 58 free comments).
Others were more relevant to the content
itself. The leading topics were educational
materials (refresher courses, clinical cases,
live scenarios, etc.) and guidelines. Other
notable comments concerned enriching our
bank of relevant links (3), to create webpages
in the national languages of ESA countries (3)
and to organise problem-oriented discussions
among experts and website users (2).
Current literature
With regards to the literature highlights,
a special form of web-presentation (and
a special page of the website!) may be
created for this purpose. The principal idea
of the original article, topic and highlights
of fundamental review or monograph would
be presented with data necessary for users
in order to understand the text themselves.
Since a complete monthly review of world
literature on anaesthesiology is an unachievable goal, impossible task, we are planning
to invite leading specialists to participate in
this “professional notice-board”.
What do users think about ESA website?
Konstantin Lebedinskiy, ESA Website Editor and member of the Media Committee
On that note, the ESA is well aware that for
many of our users that intensive care almost
as important as anaesthesia!
‘Education’ page of ESA website
TABLE OF CONTENTS
(in English)
A first step
With the recent formation of the CEEA (see
advert on page 4), we would propose exploring
and discussing the CEEA Course Programme as
a possible “Table of Contents” for our educational page. The Media Committee invites
to the discussion and further collaboration
the ESA Committee for European Education
in Anaesthesiology, Education and Training
Committee, Academic Affairs Committee,
Examinations Committee, all the Society
members and experts interested in the
problem.
If you have any thoughts or ideas about
the website, the Media Committee would be
pleased to hear from you
([email protected]). II
http://www.euroanesthesia.org/
sitecore/content/Education/CEEA%20
Courses/Course%20Programme.aspx
‘Problem-oriented websites
Relevant webpages
Lecture presentations
Latest review articles
Assessments (MCQs etc)
Books and chapters
Email address of experts
1
1.1
1.1.1
1.1.2
1.1.3
1.2
1.2.1
1.2.2
1.2.3
1.3
1.4
1.5
1.6 1.6.1
1.6.2
1.6.3
1.7
1.7.1
1.7.2
1.7.3
1.7.4
1.7.5
1.8
1.9
...
RESPIRATORY AND THORAX
Physics and principles of measurement
Physical laws
Vaporisers
Monitoring anaesthetic gases
Respiratory physiology
Ventilation
Carbon dioxide metabolism; Capnography
Oxygen metabolism. Oximetry
Anaesthesia for patients with respiratory failure
Anaesthesia for thoracic surgery
Postoperative respiratory distress
Intensive care for respiratory distress
Acute asthma
ARDS
Pulmonary oedema
Techniques
Anaesthetic circuits
Ventilators
Modes of ventilation
Respiratory monitoring
Fibreoptic bronchoscopy
Professional risks
Selection of ventilatory modes
Language specific page
Choose language
English
Francais
Deutsch
Italiano
Espanol
Pycckhh...
List of languages available
for this topic
Choose topic
President honoured by Dutch Association of
Nurse Anesthetists
The ESA is delighted to announce that the
president of the ESA, Prof. Hans Knape,
was appointed as a Member of Merit of the
Dutch Association of Nurse Anesthetists
(NVAM). There have been only two Members
of Merit appointed in the 25 year history of
the NVAM.
The NVAM told the ESA:
‘Prof. Knape received his award for his outstanding work for the NVAM (since 1985). He is a
warm ambassador not only for the NVAM but
also for nurse anesthetists in Europe. He is
always willing to serve as a chairman, consultant and advisor for the board of the NVAM.
The NVAM is very proud to decorate him with
this award.’
The NVAM is the only organisation in Holland
for Nurse Anesthetists. The NVAM is one of
the founders of the International Federation
of Nurse Anesthetists (IFNA) and is proud that
our Dutch colleague and Board member, Jaap
Hoekman as 1st vice-president of the IFNA.
The NVAM has an important role in the
education of the nurse anaesthetists both in
theory and in practice. A brand new educational curriculum has just been finalised. The
NVAM has produced many guidelines for its
members, in close cooperation with the Dutch
Association of Anesthesiologists (NVA).
The NVAM organises many workshops and has
its own national anaesthesia congress (last
January even with more than 1000 participants) including one of the largest anaesthesia exhibits in Europe.
The NVAM is honoured to be the next host
for the 9th World Congress of Nurse Anesthetists in June 2010 in The Hague (the second
one was also in The Netherlands, in 1988 in
Amsterdam). II
The Dutch Association of Nurse
Anesthetists
The Dutch Association of Nurse Anesthetists (NVAM) was founded in May 1983. At
present, the NVAM is a large organisation
in the Netherlands with approximately 1800
members (out of around 2300 nurse anesthetists in total in Holland).
H. Knape, ESA President, appointed
as a Member of Merit of the NVAM
P a g e 15
Abstracts for Euroanaesthesia 2009
A major attraction of Euroanaesthesia is the presentation of research
from around the world in the abstract
sessions. In common with previous
years, the accepted abstracts are
predominantly from Europe. Spain,
Germany and the UK continue to
provide the largest single proportions
of abstracts. This year the abstracts
are slightly more evenly distributed
however, with a few more from further
a field both within and without the
European area.
The poster presentation format is
generally working well, and discussions
between chairs, presenters and audience
seems to be more natural and lively than
previously.
The ESA Secretariat has
worked hard at improving the experience for all concerned, reducing scheduling conflicts and potential noise to the
minimum.
Voices of the future
It is undoubtedly worth making the effort
to view some of the posters and hear
some of the poster presentations. Some
of these young presenters are likely to be
the ‘big names’ in European anaesthesiology in years to come. II
The ESA is always impressed by the quality
of the submitted abstracts and this year
is no exception. This year 797 abstracts
were accepted out of 1195 submitted an
acceptance rate consistent with recent
years.
Book review - Crisis Management in Acute Care Settings
Bryn Baxendale, Notthingham, UK
The authors have set
out to introduce readers
to the field of ‘human
factors’
(sometimes
colloquially
termed
‘non-technical
skills’) that influence
our every day ability
to perform effectively
and safely at work in the context of acute
clinical care. The premise of the subject is
that modern healthcare is an example of a
complex ‘socio-technical system’ in which
human behaviour dominates processes and
outcomes of care. Historically there has been
little attention paid (until recently) to translating and applying knowledge described
within psychological and sociological science
to healthcare either through informing the
education and training of students and staff
or by application to the development of safer
clinical systems at the organisational level.
From the practising clinician’s point of view
‘Crisis Management in Acute Care Settings’ is
a useful addition to the published literature
summarising current
understanding of individual, team, and organisational issues that can influence patient
safety in the complexity of acute care in a
health system. The authors combine throughout the book to bring a clinical and psychological perspective to the text, and this is
exemplified by the use of insightful clinical
case studies at the start of each chapter
to highlight the relevance and potential
application of the psychological theories
described subsequently. The presentation of
this information uses language that is not
jargon-heavy, and frequent diagrams and
other illustrations ensure the text is comprehensible and easily digested by readers who
are unfamiliar with this field.
Each chapter stands alone and can be read in
isolation whilst overall the book is organised
helpfully into an introductory overview
of underlying theories of error, complexity, and human behaviour, followed by
sections concentrating on individual factors,
teamwork and leadership, and finishing with
organisational issues influencing error and
safe practice.
All chapters conclude with a succinct summary
(“in a nutshell”) and are well-referenced
allowing easy pursuit of further reading for
those wishing to explore the subject in more
depth.
I believe this book will be enjoyed by clinicians involved in any aspect of acute healthcare provision, and will cause many to pause
and think about their own working environment and behaviour in a different light. It
will be a useful addition to Departmental
libraries, and would be a valuable resource
for those specifically involved in developing and providing healthcare education and
training. II
Crisis management in acute care settings
M. St Pierre, G. Hofinger and C.
Buerschaper, Berlin, Germany
[Springer, Berlin. 2008]
ISBN 978-3-540-71061-5
Hardcover, 234 pages (€39.95)
Book reviews
The ESA newsletter receives various requests for book reviews from publishers. The editor would be interested to hear from members who
would like to write a book review. If you are interested please e-mail the editor at [email protected] with details of your
correspondence address, e-mail and sub-specialty interest.
P a g e 16
Setting a high European standard for
Anaesthesiology and Intensive Care
Have you ever considered a unique
opportunity to raise your training to a
European level ?
The European Society of Anaesthesiology organises
a two-part examination, the European Diploma
in
that
Anaesthesiology
is
endorsed
and
by
the
Intensive
Care
European
(EDA)
Board
of
Anaesthesiology. Thanks to the assessment of the
candidates by an independent board of European
Examiners, the EDA helps anaesthesiologists wishing
to apply for high quality posts or wishing to practice in
any European country. For more information please
visit www.euroanesthesia.org or contact us directly at
[email protected].
European Society of Anaesthesiology
24, rue des Comédiens
BE-1000 Brussels
Phone: +32 (0)2 743 32 99
Fax: +32 (0)2 743 32 98
www.euroanesthesia.org
P a g e 17
7657_ESA_ad EDA A4_DEF.indd 1
03-03-2008 10:12:13
Future Anaesthesia Meetings
May, 12 – 14
May, 27
16th World Congress on Disaster and
Emergency Medicine (WCDEM 2009)
Contact: [email protected];
http://www.wcdem2009.org
Victoria, Canada
AAGBI Regional Core Topics Programme 2009
Contact: [email protected];
http://www.aagbi.org/events/act.htm
Sheffield, UK
June, 5 – 6
May, 15 – 17
12th Eurosiva Meeting
Contact: [email protected];
http://www.eurosiva.org/
Marriott Hotel, Milan, Italy
California Society of Anesthesiologists 2009 Annual Meeting
Contact: [email protected];
http://www.csahq.org/up-more.php?idx=34
Monterey, California, USA
June, 5 - 7
4th International Travelling Pain Symposium
Contact: [email protected];
http://www.paincentreatgstt.blogspot.com
London, UK - Loire Valley, France
May, 20 – 22
June, 06 – 09
May, 20 - 22
Prague Congress - Transfusion Practice & Transfusion
Alternatives. From Blood Bank to Perioperative Period
Contact: [email protected];
http://www.praguetransfusion.com/default.asp
Prague, Czech Republic
May, 23
2nd Interventional Cadaver Workshop – Pain
Relief & Neuromodulation Procedures
Contact: [email protected];
http://www.paincentreatgstt.blogspot.com
Bialystok, Poland
May, 26 – 29
Spanish National Meeting on Anesthesiology organised
by Spanish Society of Anesthesiology (SEDAR)
Contact: http://www.sedar2009.com/WEB/
Salamanca, Spain
2009
2009
Obstetric Anaesthesia 2009
Contact: http://www.oaa-anaes.ac.uk
Jersey, Channel Islands
Euroanaesthesia 2009
Contact: [email protected]
http://www.euroanesthesia.org
Milan, Italy
June, 25 – 26
First Signa Vitae® International Conference in Paediatric / Neonatal Intensive Care and Anaesthesiology
Contact: [email protected];
http://signavitae.com/
Split, Croatia
July, 1- 3
Group of anaesthetists in training CAMBRIDGE 2009
Contact: http://www.aagbi.org/events/gatasm.htm
Cambridge, UK
August 28 – September 1
10th Congress WFSICCM, 63° Congresso
SIAARTI, 6th Annual Congress WFCCN
Contact: [email protected]
http://www.wfsiccm-florence2009.it
Florence, Italy
Milan, Italy
2009
Euroanaesthesia
The European Anaesthesiology Congress
P a g e 18
June 6-9
Future Anaesthesia Meetings
September, 9 - 12
October, 26 – 30
XXVIII Annual ESRA Congress - European Society
of Regional Anaesthesia & Pain Therapy
Contact: [email protected];
http://www2.kenes.com/esra2009/Pages/Home.aspx
Salzburg, Austria
CSA Fall Hawaiian Seminar
Contact: http://www.csahq.org/
Poipu Beach, Kauai
October, 29
AAGBI Regional Core Topics Programme 2009
Contact: [email protected];
http://www.aagbi.org/events/act.htm
Glasgow, UK
September, 9 - 12
6th Congress of the European Federation of IASP Chapters - EFIC 2009
Contact: [email protected]
Lisbon, Portugal
Annual Congress 2009
Contact: http://www.aagbi.org/events/congress.htm
Liverpool, UK
2009
September, 23 - 25
November, 4
November, 25
September, 23 – 25
AAGBI Regional Core Topics Programme 2009
Contact: [email protected];
http://www.aagbi.org/events/act.htm
Nottingham, UK
December, 11 – 15
63rd PostGraduate Assembly in Anesthesiology (PGA)
Contact: [email protected]
https://nyssa-pga.net
New York, USA
September, 23 – 26
20th Meeting – ESCTAIC
Computing and Technology in Anesthesia and
Intensive Care
Contact: [email protected];
http://www.esctaic.org
Berlin & Potsdam, Germany
January, 18 – 22
CSA Winter Hawaiian Seminar
Contact: http://www.csahq.org/
Ka’anapali Beach, Maui
September, 23 - 26
March, 7 – 12
51th Congress of the SFAR
Contact: [email protected];
http://www.sfar2009.com
Paris, France
NYSORA World Anesthesia Congress (NWAC)
Contact: [email protected];
http://www.nysoraworld.com/
Dubai, United Arab Emirates
September, 24 – 25
October, 2
AAGBI Regional Core Topics Programme 2009
Contact: [email protected];
http://www.aagbi.org/events/act.htm
Wessex, UK
October, 11 – 14
22nd ESICM Annual Congress
Contact: [email protected]
http://www.esicm.org
Austria, Vienna
May, 14 - 16
2010
2009
VI Baltic Congress & Exhibition - Transfusion Practice
& Transfusion Alternatives. From Blood Bank to
Perioperative Period
Contact: http://www.rigatransfusion.com/
Riga, Latvia
4th London Regional Anaesthesia Workshop
Contact: http://www.lsora.co.uk
London, UK
AAGBI Regional Core Topics Programme 2009
Contact: [email protected];
http://www.aagbi.org/events/act.htm
Nottingham, UK
CSA Annual Meeting and Clinical Anesthesia Update
Contact: http://www.csahq.org/
Costa Mesa, California, USA
June, 12 – 15
Euroanaesthesia 2010
Contact: [email protected]
http://www.euroanesthesia.org
Helsinki, Finland
November, 1 - 5
CSA Fall Hawaiian Seminar
Contact: http://www.csahq.org/
Kona, Hawai
P a g e 19
Milan, Italy
2009
Euroanaesthesia
The European Anaesthesiology Congress
Symposia
Refresher Courses
Workshops
Industrial Symposia & Exhibition
Abstract Presentations
CME Accreditation
EACCME - UEMS
June 6-9
ESA Secretariat
Phone +32 (0)2 743 32 90
Fax +32 (0)2 743 32 98
E-mail: [email protected]