Crisis Management: Promoting a Standard

The ACM project is aiming to standardise crisis management and improve patient safety by providing protocols, checklists and diagnostic pathways (consistent with the European Society of Anaesthesiology’s Helsinki Declaration on Patient Safety in Anaesthesiology, 2010) in all operating and anaesthetising environments.

The first step in this implementation is to have a hard copy of the manual attached to all anaesthetic machines, trolleys or carts. Although there is considerable demand for smartphone and tablet formats, it is recognised by many working in this field, including the Stanford Anaesthetic Cognitive Aid Group and the Harvard associated Ariadne Labs, that in simulated crisis scenarios, the hard copy is still the most effective means of conveying information quickly, with minimal confusion in stressful conditions. (If your department does not have hard copies, they can be purchased with bulk order discounts from the website

However, core components of effective crisis management include good clinical training, regular rehearsal and being well prepared. This means getting the clinician to engage with the culture of cognitive aids, rehearse diagnostic checklists and regularly review protocols. We consider this the second step in implementation of crisis or emergency manuals.

To promote this engagement, and in response to feedback from clinicians, we have produced a ‘hybrid’ e-version of the manual. Hybrid, because there are some basic ‘app-like’ interactive components to help navigate quickly though the contents. We think this feature will be well received, but strongly encourage feedback from users to make the manual even better.

The third, and possibly most important stage of our implementation strategy, is the teaching benefit of having a crisis manual in every operating room. Many of us who work in tertiary institutions are involved with teaching and training future anaesthesiologists, anaesthetists and anaesthetic or operating department assistants. The presence of an ACM in operating locations enables regular testing and challenging of all clinicians in both differential diagnosis and emergency checklists. This ongoing exposure creates awareness and familiarity, and with time we hope will encourage cognitive aid use and crew resource management principles. This third stage of implementation we hope to complete with the soon to be released app, driven by the contents of The Anaesthetic Crisis Manual.

Thank you for promoting the patient safety message and the role of cognitive aids.

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