The influence of the anaesthetist on outcome

Anaesthetists are faced with an increasing number of patients who are at high risk and who undergo increasingly extensive and prolonged surgical interventions. Increasing financial restrictions within health care systems exert pressure on departments of anaesthesia to undertake a constantly increasing workload. Departments in turn require individual anaesthetists to work harder and to cope with a progressively more complex case mix, often working longer hours with little or no cover for breaks. Although improved monitoring, better training and the introduction of compulsory continuing medical education should reduce errors and improve outcome, the increased pressures on anaesthetists may negate the effects of these improvements. This chapter describes the sources of human and system-based errors, explores factors which influence the risk of errors by individual anaesthetists and considers whether the consequences of errors lead to an increased risk of adverse outcome among high-risk patients in particular.