ERRORS, INCIDENTS AND ACCIDENTS IN ANESTHETIC PRACTICE

Human error is a pervasive and normal part of everyday life and is of interest to the anaesthetist because errors may lead to accidents. Def initions of, and the relationships between, errors, incidents and acci dents are provided as the basis to this introduction to the psychology of human error in the context of the work of the anaesthetist. Exampl es are drawn from the Australian Incident Monitoring Study (AIMS). An argument is put forward for the use of contemporaneous incident report ing (eliciting relevant contextual information as well as details of u se to cognitive psychologists), rather than the use of accident invest igation after the event (with the inherent problems of scant informati on, altered perception and outcome bias). A classification of errors i s provided. ''Active'' errors may be classified into knowledge-based, rule-based, skill-based and technical errors. Different strategies are required for the prevention of each type and it may now be useful to place more emphasis in anaesthetic practice on categories to which lit tle attention has been directed in the past. ''Latent'' errors make an enormous contribution to problems in anaesthesia and several categori es are discussed (eg. environment, physiological state, equipment, wor k practices, personnel training, social and cultural factors). An appr oach is provided for the prevention and management of errors, incident s and accidents which allows clinical problems to be categorized, the relative importance of various contributing factors to be established, and appropriate preventative strategies to be devised and implemented on the basis of priorities determined from the AIMS data. Accidents c annot be abolished; however, an understanding of the factors underlyin g them can lead to the rational direction of resources and effort to p revent them and minimise their effects.