BJA
Correspondence
4 Phipps DL, Parker D, Meakin GH, Beatty PCW. Determinants of intention to deviate from clinical guidelines. Ergonomics 2010; 53: 393–403 5 Phipps DL, Parker D, Pals EJM, Meakin GH, Nsoedo C, Beatty PCW. Identifying violation provoking factors in a healthcare setting. Ergonomics 2008; 51: 1625– 42 6 Smith A, Goodwin D, Mort M, Pope C. Expertise in practice: an ethnographic study exploring acquisition and use of knowledge in anaesthesia. Br J Anaesth 2003; 91: 319–28 7 Zala-Mezo¨ E, Wacker J, Ku¨nzle B, Bru¨esch M, Grote G. The influence of standardisation and task load on team coordination patterns during anaesthesia inductions. Qual Saf Health Care 2009; 18: 127–30 8 Alper SJ, Karsh B-T. A systematic review of safety violations in industry. Accid Anal Prev 2009; 41: 739– 54
doi:10.1093/bja/aet451
Editor—We thank Dr Phipps for his thoughtful comments on our case report.1 Data suggesting that human factors play a role in the qualitative aspects of an anaesthetist’s preoperative assessment are interesting. They add strength to the argument that mandated processes may minimize inter-clinician variability and ensure that certain actions occur during the preoperative assessment process. We agree that for any checklist-based system to be useful, the end-users need to be fully engaged in the process of development and implementation. When creating semi-automated processes for preoperative data collection, we felt it imperative to involve multiple clinicians from multiple sites.2 Moreover, it is our opinion that this engagement should extend to other craft groups such as nursing and pharmacy, to address crossgroup issues. It is to be hoped that a comprehensive, relevant, and succinct preoperative assessment based on appropriately designed checklists will make preoperative patient review a streamlined process. In other words, the inconvenience for the anaesthetist is reduced with the assurance that all relevant aspects of the patient’s preoperative assessment have been covered. It may even be possible for certain patients traditionally mandatorily seen in the preoperative assessment clinic to bypass this altogether. Armed with effective information, comprehensive assessment by anaesthetists and other clinicians can then be completed on the day of operation. Ultimately of course, Dr Phipps is correct that validation of this approach in clinical practice must formally address issues such as quality, safety, workflows, and costs if the value proposition of preoperative checklists is to be proven.
Declaration of interest None declared. T. Painter* G. L. Ludbrook
172
1 Painter T, Ludbrook GL. Reducing system errors in the preoperative assessment process. Br J Anaesth 2013; 110: 1060– 1 2 Grant C, Ludbrook GL, O’Loughlin EJ, Corcoran TB. An analysis of computer-assisted pre-screening prior to elective surgery. Anaesth Intensive Care 2012; 40: 297– 304
doi:10.1093/bja/aet448
Is no nausea worth a little insulin? Editor—In his editorial,1 Dr Dhatariya asks, ‘Or do the benefits of administering corticosteroids outweigh the potential sideeffects of short-lasting hyperglycaemia?’, but makes no attempt to answer it. With a quick PubMed search, I found several outcome studies, including one meta-analysis analysing 13 randomized controlled trials,2 that showed no adverse effects of single-dose dexamethasone given for postoperative nausea and vomiting prophylaxis. If this represents the ‘Con’ editorial, readers can find the ‘Pro’ version in the May 2013 issue of Anesthesia and Analgesia.3 It comments on an accompanying article4 that reviews the outcome of 431 gynaecologic oncology patients that found no increase in wound infections among patients who received dexamethasone. Finally, it is unfortunate that a patient’s experience of pain or nausea is not considered as important as short-lasting hyperglycaemia, especially now that glycaemic control is such a high priority in perioperative medicine. Is no nausea worth a little insulin?
Declaration of interest None declared. G. C. Allen* Washington, USA * E-mail: [email protected] 1 Dhatariya K. Does dexamethasone-induced hyperglycaemia contribute to postoperative morbidity and mortality? Br J Anaesth 2013; 110: 674–5 2 Pham A, Liu G. Dexamethasone for antiemesis in laparoscopic gynecologic surgery: a systematic review and meta-analysis. Obstet Gynecol 2012; 120: 1451–8 3 Khan SA, McDonagh DL, Gan TJ. Wound complications with dexamethasone for postoperative nausea and vomiting prophylaxis: a moot point? Anesth Analg 2013; 116: 966–8 4 Bolac CS, Wallace AH, Broadwater G, Havrilesky LJ, Habib AS. The impact of postoperative nausea and vomiting prophylaxis with dexamethasone on postoperative wound complications in patients undergoing laparotomy for endometrial cancer. Anesth Analg 2013; 116: 1041–7
doi:10.1093/bja/aet449
Downloaded from http://bja.oxfordjournals.org/ at Belgorod State University on December 6, 2013
Reply from the authors
Adelaide, Australia E-mail: [email protected]
*
Correspondence
4 Phipps DL, Parker D, Meakin GH, Beatty PCW. Determinants of intention to deviate from clinical guidelines. Ergonomics 2010; 53: 393–403 5 Phipps DL, Parker D, Pals EJM, Meakin GH, Nsoedo C, Beatty PCW. Identifying violation provoking factors in a healthcare setting. Ergonomics 2008; 51: 1625– 42 6 Smith A, Goodwin D, Mort M, Pope C. Expertise in practice: an ethnographic study exploring acquisition and use of knowledge in anaesthesia. Br J Anaesth 2003; 91: 319–28 7 Zala-Mezo¨ E, Wacker J, Ku¨nzle B, Bru¨esch M, Grote G. The influence of standardisation and task load on team coordination patterns during anaesthesia inductions. Qual Saf Health Care 2009; 18: 127–30 8 Alper SJ, Karsh B-T. A systematic review of safety violations in industry. Accid Anal Prev 2009; 41: 739– 54
doi:10.1093/bja/aet451
Editor—We thank Dr Phipps for his thoughtful comments on our case report.1 Data suggesting that human factors play a role in the qualitative aspects of an anaesthetist’s preoperative assessment are interesting. They add strength to the argument that mandated processes may minimize inter-clinician variability and ensure that certain actions occur during the preoperative assessment process. We agree that for any checklist-based system to be useful, the end-users need to be fully engaged in the process of development and implementation. When creating semi-automated processes for preoperative data collection, we felt it imperative to involve multiple clinicians from multiple sites.2 Moreover, it is our opinion that this engagement should extend to other craft groups such as nursing and pharmacy, to address crossgroup issues. It is to be hoped that a comprehensive, relevant, and succinct preoperative assessment based on appropriately designed checklists will make preoperative patient review a streamlined process. In other words, the inconvenience for the anaesthetist is reduced with the assurance that all relevant aspects of the patient’s preoperative assessment have been covered. It may even be possible for certain patients traditionally mandatorily seen in the preoperative assessment clinic to bypass this altogether. Armed with effective information, comprehensive assessment by anaesthetists and other clinicians can then be completed on the day of operation. Ultimately of course, Dr Phipps is correct that validation of this approach in clinical practice must formally address issues such as quality, safety, workflows, and costs if the value proposition of preoperative checklists is to be proven.
Declaration of interest None declared. T. Painter* G. L. Ludbrook
172
1 Painter T, Ludbrook GL. Reducing system errors in the preoperative assessment process. Br J Anaesth 2013; 110: 1060– 1 2 Grant C, Ludbrook GL, O’Loughlin EJ, Corcoran TB. An analysis of computer-assisted pre-screening prior to elective surgery. Anaesth Intensive Care 2012; 40: 297– 304
doi:10.1093/bja/aet448
Is no nausea worth a little insulin? Editor—In his editorial,1 Dr Dhatariya asks, ‘Or do the benefits of administering corticosteroids outweigh the potential sideeffects of short-lasting hyperglycaemia?’, but makes no attempt to answer it. With a quick PubMed search, I found several outcome studies, including one meta-analysis analysing 13 randomized controlled trials,2 that showed no adverse effects of single-dose dexamethasone given for postoperative nausea and vomiting prophylaxis. If this represents the ‘Con’ editorial, readers can find the ‘Pro’ version in the May 2013 issue of Anesthesia and Analgesia.3 It comments on an accompanying article4 that reviews the outcome of 431 gynaecologic oncology patients that found no increase in wound infections among patients who received dexamethasone. Finally, it is unfortunate that a patient’s experience of pain or nausea is not considered as important as short-lasting hyperglycaemia, especially now that glycaemic control is such a high priority in perioperative medicine. Is no nausea worth a little insulin?
Declaration of interest None declared. G. C. Allen* Washington, USA * E-mail: [email protected] 1 Dhatariya K. Does dexamethasone-induced hyperglycaemia contribute to postoperative morbidity and mortality? Br J Anaesth 2013; 110: 674–5 2 Pham A, Liu G. Dexamethasone for antiemesis in laparoscopic gynecologic surgery: a systematic review and meta-analysis. Obstet Gynecol 2012; 120: 1451–8 3 Khan SA, McDonagh DL, Gan TJ. Wound complications with dexamethasone for postoperative nausea and vomiting prophylaxis: a moot point? Anesth Analg 2013; 116: 966–8 4 Bolac CS, Wallace AH, Broadwater G, Havrilesky LJ, Habib AS. The impact of postoperative nausea and vomiting prophylaxis with dexamethasone on postoperative wound complications in patients undergoing laparotomy for endometrial cancer. Anesth Analg 2013; 116: 1041–7
doi:10.1093/bja/aet449
Downloaded from http://bja.oxfordjournals.org/ at Belgorod State University on December 6, 2013
Reply from the authors
Adelaide, Australia E-mail: [email protected]
*
