Go/No-Go Decision in Anaesthesia: Wide Variation in Risk Tolerance Amongst Anaesthetists

Greig R,  Higham  HE, Darbyshire  JL and Vincent C.

British Journal of Anaesthesia 2017; 118 (5): 740–6.

https://doi.org/10.1093/bja/aew444

Background/Methods

Within the aviation and military sectors there are many operational checks which may be carried out prior to commencement of any task – these checks are often referred to as ‘go/no-go’ decisions. Similarities between these industries and anaesthesia have often been drawn and likewise there are numerous checks that an anaesthetist carries out daily prior to commencing any anaesthetic. Multiple factors may contribute to the decision to start or cancel a procedure including patient, operational and personal reasons.

Little is known about exactly what factors influence anaesthetists to make such decisions and how individual risk analysis occurs. This study presented a small number of anaesthetists with 11 ‘sub-optimal’ scenarios (based on previous critical incidents) via questionnaire – asking each if they would proceed or not, why, and if they felt others of a similar standing would concur.

 

Analysis/Results

Data was collated based on demographics of the group, likelihood to proceed with each scenario and opinion as to whether their decision would be corroborated by colleagues. Data was analysed via Independent t-tests (continuous) and chi-squared tests (variable). Results between trainee and consultant/SAS grades were compared.

A total of 59 anaesthetists responded (28% of those invited to participate; of which 69% were consultant/SAS grade and 31% were trainees).

Unsurprisingly perhaps, consultants were more likely to proceed with tasks in un-ideal situations. Both groups felt that their decisions would be the same as colleagues of a similar training level (statistically significant), however there was considerable variation between opinions on each scenario.

In 6 of 11 proposed scenarios there was an overall consensus as to whether it should be a ‘go’ or ‘no-go’ procedure; yet those opposing the majority still thought, incorrectly, that others would do the same. Analysis of the reasons given to support each decision revealed common themes including concerns over patient safety, exposure to similar circumstances previously and perceived pressures operational or otherwise.

Discussion

Many factors may influence an anaesthetist’s decisions to proceed with or cancel a case given various obstacles. Even amongst anaesthetists there is no clear consensus as to what constitutes a ‘go/no-go’ decision despite various guidelines which may suggest there should be. These decisions may be attributable to individual personality traits, workplace ethics and experience, however it is clear significant variability remains.

Kingston journal club felt that one of the most notable findings was that most anaesthetists felt their decisions would be corroborated by colleagues despite there being no evidence to support this.

The authors feel a consensus amongst the multi-disciplinary team as to specific standards constituting a ‘go/no-go’ decision would be helpful and that this is needed before wider organisational and managerial attitudes can be changed to ensure patient safety takes president over procedural and financial targets. Maybe we should all think twice (and phone a friend) before we ‘go’ next time…

Summary by Dr S. Bacciarelli. Journal Club 04 January 2018.

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