Near misses occur frequently in perioperative care but are inconsistently reported, limiting their contribution to system-level safety improvement. A cross-sectional survey was administered to anesthesia providers at a single academic center to assess near miss experience, reporting behavior, perceived barriers, and event classification accuracy using clinical vignettes. Forty-nine respondents (17.3% response rate) participated. Nearly all respondents (98.0%) reported exposure to a near miss, while 42.9% indicated that such events were reported. The most identified barriers included reporting process complexity (55.1%), uncertainty about reporting procedures (42.9%), and ambiguity in event classification (38.8%). Scenario-based assessment demonstrated substantial variability in distinguishing near miss from no-harm events, particularly in routine or borderline clinical scenarios. These findings define key areas for targeted intervention to improve near miss reporting.

There is increasing evidence that prehabilitation before surgery may improve patient outcomes and should be established in perioperative care pathways. We aimed to explore the logistics of running a randomised controlled study delivering multimodal prehabilitation (exercise and lifestyle modification) of patients having aortic aneurysm repair. Our primary objective was to assess the feasibility of recruitment, retention, and adherence to study interventions. Secondary objectives were patient outcomes such as function, quality of life and postoperative complications. A feasibility, assessor-blinded, parallel-group, randomised controlled trial. Following ethical approval, adults scheduled for elective open or endovascular abdominal aortic aneurysm repair were randomised to one of three groups: (1) control, current standard practice with no prehabilitation workshop; (2) non-mentored prehabilitation, a prehabilitation workshop with no further patient contact; and (3) mentored prehabilitation, a prehabilitation workshop with addition of regular mentoring for up to eight weeks after the workshop. Primary feasibility outcomes included: adherence to study interventions (wearing trackers for >80

( Anaesthesia. 2024;79:486–497. doi:10.1111/anae.16241) Discrepancies in maternal and neonatal results across diverse ethnic and socioeconomic groups have been thoroughly documented. The postnatal period is crucial to a mother’s health, as it is the time when most maternal deaths happen. Research has indicated that individuals from lower socioeconomic backgrounds have a mortality rate that is over double that of wealthier obstetric patients. Maternal mortality rates are much higher in minority ethnic groups in the UK, where Black patients have a 4-fold higher risk of death compared with White patients. In addition, Black patients are more prone to receiving general anesthesia during cesarean deliveries and experience a 30% increased rate of postpartum readmissions in comparison to White patients.

( Anaesthesia . 2023;78(9):1071–1080) The peripartum period, encompassing childbirth and its aftermath, involves the administration of anesthesia or analgesia to ∼65% of patients, a substantial portion necessitated by urgent surgical interventions. The imperative to enhance surgical recovery and ensure patient satisfaction postpartum is crucial for delivering high-quality clinical care, as it has the potential to positively influence maternal physical and psychological well-being. Despite the escalating focus on postpartum-related research, prior studies on recovery have been predominantly confined to single-center endeavors with limited sample sizes, deploying disparate outcome measures or unvalidated metrics, primarily evaluating inpatient recovery with insufficient scrutiny of outpatient recovery.

Background Variability in obstetric anaesthetia practice and care delivered within the UK is under-explored. The ObsQoR study explored structures, processes, and outcomes of obstetric anaesthesia in 107 hospitals within the UK's National Health Service, and the results of the hospital-level survey are reported here. Methods Hospitals were surveyed to assess obstetric anaesthesia provision, practice, and care delivery. Questions explored staffing, service provision and training, facilities present, clinical practices, outcome measurement, and key indicators of quality in obstetric anaesthesia. Results We received responses from 106 participating hospitals, representing 69% of all UK obstetric units. One hundred (94%) hospitals had a dedicated consultant obstetric anaesthetist within working hours, with 27 (25%) of hospitals' duty anaesthetists having additional clinical responsibilities outside the care of obstetric patients outside of working hours. Around 102 hospitals (98%) offer multidisciplinary team training, of which 95 (93%) use a simulation-based method. Dedicated high-risk antenatal clinics were present in 50 (47%) hospitals. The majority of hospitals provide written patient information in multiple languages for discussing obstetric anaesthesia options (77, 82%). Seventy-three hospitals (69%) use point-of-care testing to estimate haemoglobin concentration. Labour epidural analgesia is most commonly delivered via patient-controlled epidural analgesia in 80 (76%) hospitals, and the incidence of post-dural puncture headaches was recorded by 80 (76%) hospitals. Conclusions These results demonstrate variation in the provision of staffing, facilities, clinical practices, and outcome measurements across the UK. To deliver safe and equitable care across the UK, there needs to be standardisation of anaesthetic peripartum care based on national recommendations and the benchmarking and measurement of appropriate markers of quality.

Summary Disparities relating to postpartum recovery outcomes in different socio‐economic and racial ethnic groups are underexplored. We conducted a planned analysis of a large prospective caesarean delivery cohort to explore the relationship between ethnicity, socio‐economic status and postpartum recovery. Eligible patients were enrolled and baseline demographic, obstetric and medical history data were collected 18 h and 30 h following delivery. Patients completed postpartum quality of life and recovery measures in person on day 1 (EuroQoL EQ‐5D‐5L, including global health visual analogue scale; Obstetric Quality of Recovery‐10 item score; and pain scores) and by telephone between day 28 and day 32 postpartum (EQ‐5D‐5L and pain scores). Socio‐economic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence. Data from 1000 patients who underwent caesarean delivery were included. There were more patients of Asian, Black and mixed ethnicity in the more deprived quintiles. Patients of White ethnicities had shorter postpartum duration of hospital stay compared with patients of Asian and Black ethnicities (35 (28–56 [18–513]) h vs. 44 (31–71 [19–465]) h vs. 49 (33–75 [23–189]) h, respectively. In adjusted models at day 30, patients of Asian ethnicity had a significantly greater risk of moderate to severe pain (numerical rating scale ≥ 4) at rest and on movement (odds ratio (95%CI) 2.42 (1.24–4.74) and 2.32 (1.40–3.87)), respectively). There were no differences in readmission rates or incidence of complications between groups. Patients from White ethnic backgrounds experience shorter postpartum duration of stay compared with patients from Asian and Black ethnic groups. Ethnic background impacts pain scores and recovery at day 1 postpartum and following hospital discharge, even after adjusting for socio‐economic group. Further work is required to understand the underlying factors driving differences in pain and recovery and to develop strategies to reduce disparities in obstetric patients.

BACKGROUND:Several health care networks have fully adopted second-generation supraglottic airway (SGA) i-gel. Real-world evidence of enhanced patient safety after such practice change is lacking. We hypothesized that the implementation of i-gel compared to the previous LMA®-Unique™ would be associated with a lower risk of airway-related safety events. METHODS:Adult patients undergoing general anesthesia with LMA-Unique or i-gel between January 2013 and June 2020 at an academic health care network were included. We assessed the influence of i-gel implementation on the trends of intraoperative airway-related safety events, a composite outcome of respiratory disturbances including intraoperative desaturation (<90%), hypo- or hypercapnia (<25 or >50 mm Hg), high driving pressures (>30 cmH2O), low tidal volumes (<4 mL/kg), multiple attempts of SGA placement, or emergency replacement with a tracheal tube, using adjusted ordinary least-squares regression interrupted time series analysis. RESULTS:A total of 21,417 patients were included, and 5193 experienced airway-related safety events (24.2%). After the wider uptake of i-gel in January 2018, the reduction in the monthly trend of airway-related safety events was magnified to -0.3% per month (95% confidence interval [CI], -0.1% to -0.4%, P < .001), compared to the LMA-Unique period (-0.2% per month, 95% CI, -0.1% to -0.3%; P = .002). CONCLUSIONS:We found a significant decline in the monthly trend of airway-related safety events after the full implementation of i-gel in our health care network. This study provides real-world patient safety and clinical effectiveness information to clinicians and decision-makers.

Summary To better understand outcomes in postpartum patients who receive peripartum anaesthetic interventions, we aimed to assess quality of recovery metrics following childbirth in a UK‐based multicentre cohort study. This study was performed during a 2‐week period in October 2021 to assess in‐ and outpatient post‐delivery recovery at 1 and 30 days postpartum. The following outcomes were reported: obstetric quality of recovery 10‐item measure (ObsQoR‐10); EuroQoL (EQ‐5D‐5L) survey; global health visual analogue scale; postpartum pain scores at rest and movement; length of hospital stay; readmission rates; and self‐reported complications. In total, 1638 patients were recruited and responses analysed from 1631 (99.6%) and 1282 patients (80%) at one and 30 days postpartum, respectively. Median (IQR [range]) length of stay postpartum was 39.3 (28.5–61.0 [17.7–513.4]), 40.3 (28.5–59.1 [17.8–220.9]), and 35.9 (27.1–54.1 [17.9–188.4]) h following caesarean, instrumental and vaginal deliveries, respectively. Median (IQR [range]) ObsQoR‐10 score was 75 ([62–86] 4–100) on day 1, with the lowest ObsQoR‐10 scores (worst recovery) reported by patients undergoing caesarean delivery. Of the 1282 patients, complications within the first 30 days postpartum were reported by 252 (19.7%) of all patients. Readmission to hospital within 30 days of discharge occurred in 69 patients (5.4%), with 49 (3%) for maternal reasons. These data can be used to inform patients regarding expected recovery trajectories; facilitate optimal discharge planning; and identify populations that may benefit most from targeted interventions to improve postpartum recovery experience.

Background: The management of obstetric patients with coronavirus disease 2019 (COVID-19) due to human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires unique considerations. Many aspects of labour and delivery practice required adaptation in response to the global pandemic and were supported by guidelines from the Royal College of Obstetrics and Gynaecologists. The adoption and adherence to these guidelines is unknown. Methods: Participating centres in "Quality of Recovery in Obstetric Anaesthesia study-a multicentre study'' (ObsQoR) completed an electronic survey based on the provision of services and care related to COVID-19 in October 2021. The survey was designed against the Royal College of Obstetricians and Gynaecologists COVID-19 guidelines. Results: One hundred and five of the 107 participating centres completed the survey (98% response rate representing 54% of all UK obstetric units). The median [IQR] annual number of deliveries among the included sites was 4389 [3000-5325]. Ninety-nine of the 103 (94.3%) sites had guidelines for the management of peripartum women with COVID-19. Sixty-one of 105 (58.1%) sites had specific guidance for venous thromboembolism (VTE) prophylaxis. Thirty-seven of 104 (35.6%) centres restricted parturient birthing plans if a positive diagnosis of COVID-19 was made. A COVID-19 vaccination referral pathway encouraging full vaccination for all pregnant women was present in 63/103 centres (61.2%). Conclusion: We found variability in care delivered and adherence to guidelines related to COVID-19. The clinical implications for this related to quality of peripartum care is unclear, however there remains scope to improve pathways for immunisation, birth plans and VTE prophylaxis. (C) 2022 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Background and AimsVirtual Reality (VR) has been shown to reduce anxiety and pain scores for medical procedures, and in conjunction with regional anaesthesia (RA), has been reported to reduce sedation requirements, and improve patient satisfaction(1). We aimed to implement the use of VR for patients undergoing awake upper limb surgery under RA at our institution.MethodsThree Occulus Quest 2 VR headsets were kindly donated from Sintetica. The implementation process required several steps; local approval from clinical engineering and infection control to permit the use of these headsets on patients; establishing and troubleshooting the VR set up, which required disabling the boundary limit in order to have continuous use of the headset regardless of patient positioning; selecting appropriate media which included videos and immersive experiences. Patients who agreed to trial the VR headset were then asked for feedback.ResultsThe implementation of VR into our practice required technical preparation as well as local engagement to ensure multi-disciplinary awareness and buy-in, in particular from our ODPs and surgical colleagues. Initial feedback from surgeons and patients is positive, with reports noting the improved experience with VR in those with a history of previous surgeries under RA. Others noted the preferred media selection for future occurrences, such as documentaries or relaxing experiences, being mindful of which may result in nausea.ConclusionsA larger cohort of patients is required to evaluate the impact of VR as an adjunct to awake surgery on patient experience, but our preliminary service evaluation has provided very promising results.

Background In this study, we explored the utility of intravenous opioid rescue analgesia in the post anesthesia care unit (PACU-OpResc) as a single marker of thoracic epidural analgesia (TEA) failure and evaluated the resource implications and quality improvement applications of this measure. Methods We performed a retrospective analysis of all TEA placements over a three-year period at a single academic medical center in Boston, Massachusetts. The study exposure was PACU-OpResc. Primary outcome was PACU length of stay (LOS). Secondary outcomes included reasons for delayed PACU discharge and intraoperative hypotension. The analyses were adjusted for confounding variables including patient comorbidities, surgical complexity, intraoperative intravenous opioids, chronic opioid use and local anesthetic bolus through TEA catheter. Post analysis chart review was conducted to determine the positive predictive value (PPV) of PACU-OpResc for inadequate TEA. As a first Plan-Do-Study-Act cycle, we then introduced a checkbox for documentation of a sensory level check after TEA placement. Post implementation data was collected for 7 months. Results PACU-OpResc was required by 211 (22.1%) patients who received preoperative TEA, was associated with longer PACU LOS (incidence rate ratio 1.20, 95% CI:1.07–1.34, p = 0.001) and delayed discharge due to inadequate pain control (odds ratio 5.15, 95% CI 3.51–7.57, p < 0.001). PACU-OpResc had a PPV of 76.3 and 60.4% for re-evaluation and manipulation of the TEA catheter in PACU, respectively. Following implementation of a checkbox, average monthly compliance with documented sensory level check after TEA placement was noted to be 39.7%. During this time, a reduction of 8.2% in the rate of PACU-OpResc was observed. Conclusions This study demonstrates that PACU-OpResc can be used as a quality assurance measure or surrogate for TEA efficacy, to track performance and monitor innovation efforts aimed at improving analgesia, such as our intervention to facilitate sensory level checks and reduced PACU-OpResc. Trial registration not applicable.