الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Patient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often led to adverse healthcare events. The aim of the present study was to evaluate the current situation in Egypt regarding the quality of anaesthesia practice and patient safety.
The current study was a cross sectional questionnaire-based observational one, that includes 246 anaesthesiologists who responded to the proposed survey questions from different districts in Egypt. Each response was given a numerical value to establish a patient safety scoring system. Data collection was made between December 2021 to May 2022.
The majority of participants were from Cairo, representing about 37% of the total responders. Most of them were consultant anaesthesiologists. Patient safety score was found to be significantly higher when the number of attending anaesthesiologists is more than two in the working place. In addition, low patient safety scores were noted if the number of working hours per week is more than 80 hours. The majority of anaesthesiologists reported the presence of three to five operative rooms in their working theatre.
This survey also revealed that about 37.4% of anaesthesia practitioners reported that only three to five anaesthesiologists were available to cover operative rooms. About half of anaesthesiologists (54.9%) noted the lack of nurse anaesthetists and the presence of only one to two nurse anaesthetists in their hospitals, that was found to be statistically associated with lower patient safety scores in comparison to the presence of more than five nurse anaesthetists in the working place.
The obtained result showed that 49.2% reported the lack of proper anaesthesia resources in their workplace. In addition, it was noted that 48% of anaesthesia practitioners thought that their perioperative documentation in patient’s file is neither proper nor adequate.
Lack of preventive measures against environmental hazards (e.g., exposure to radiation, infection, burns, electric shock, falls, and laser) were reported by 55.7% of respondents. It was noted that 17% of anaesthesiologists disagreed to perform routinely proper labeling of anaesthesia medications, critical review of medication safety, and standardization of abbreviations in their workplace.
In addition, 41.9% of anaesthesiologist disagreed to have a sufficient continuous education activity in their department, and 38.7% of respondents agreed to have inadequate supervision of juniors’ staff by consultant in their department.
Furthermore, 36.6% of anaesthesiologists agreed that patients who received anaesthesia were firstly evaluated in the operating room. The majority of respondents (71.2%) agreed with performing routinely preoperative airway assessment in every patient. Moreover, 68.7% of anaesthesiologists agreed that performed routinely preanaesthetic machine and circuit checkup before starting anaesthesia. In contrary, 56.5% of anaesthesiologists disagreed that their workplace applied WHO Surgical Safety Checklist routinely.
The majority of respondents (93.5%) agreed that they strictly followed pre-operative fasting guidelines in patients who undergo elective surgery, as well as 47.5% of respondents agreed that they obtained written informed consent about the type of anaesthesia that they are going to implement. Furthermore, 64.7% of participants agreed with performing risk assessment for all patients undergoing surgery. In addition, 29.7% of anaesthesiologists agreed that they routinely administered premedications in their practice.
Additionally, 97.6% and 67.9% of anaesthesiologists agreed that they routinely used pulse oximetry and ECG monitoring in every case, respectively. In contrary, 40.3% of respondents disagreed with routine use of EtCO2 monitoring in every case. 59.7% of respondents agreed that they strictly followed clinical practice guidelines in their anaesthesia practice. In addition, 46.3% of participants reported that they did not have warm devices available in their workplace to maintain normothermia especially in children and elderly.
The obtained results showed that 45.9% of anaesthesiologists reported that their workplace lacked the presence of a postoperative anaesthesia care unit (PACU) as per the standards regarding the space, personnel, equipments and monitors etc., while 79.3% of anaesthesiologists reported that their anaesthesia department did not have a postoperative pain management team.
In addition, 32.2% of anaesthesiologists disagreed that they wrote an incidence report for any incidence of mortality and morbidity. However, 26% of respondents stated that their department did not have an anaesthesia incidence reporting system.
Regarding the average fees for administering anaesthesia in a private hospital for a cesarean section, 19.9%, 39.4%, 28.5%, and 12.2% of anaesthesiologists gain less than 300, 300 – 400, 400 – 500, and >500 Egyptian pounds, respectively, and 87% of respondents disagreed that their fees for administering anaesthesia in the private sector were satisfactory. Furthermore, 53.3% of practitioners agreed that they often worked without skilled assistants. In addition, 64.2% of anaesthesiologists reported that they suffered from manifestations of stress such as sleep deprivation, fatigue, mood changes, exhaustion, depersonalization, etc.
39% of anaesthesiologists reported that they experienced at least a single case of dental injury in the last 6 months. 44.3% of practitioners reported at least one incidence of intraoperative cardiac arrest (not part of a surgical procedure) in the last year, while 28% reported that they experienced at least one case of failed airway due to lack of facilities in the past month. 28.9% of practitioners reported that they experienced at least one case of medication error (wrong drug, wrong dose, wrong patient, wrong route or unjustified prescription, etc.) in the last month.
This study reported anaesthesia quality survey in Egypt. The present survey revealed several opportunities for improvement of quality and safety in Egypt. The findings of this study can help government health policy makers, hospital administrators, and different anaesthesia societies in Egypt to understand the challenges and develop strategies to improve anaesthesia patient safety.