While anaesthesia associated mortality has declined markedly over the last decades, the number of critical incidents is still significant. But why is it so difficult to control the occurrence of perioperative critical events? Anaesthesia is not just complicated, but highly complex and tightly coupled.

Standards and guidelines provide relevant information for the best treatment options to reduce outdated and inefficient practice. While standards are criteria established by authority that result in best outcomes, guidelines are “practical helpers” that explain how to perform a task. Guidelines and cognitive aids offer the possibility to bundle this enormous amount of knowledge and provide it to clinicians.

All these aids are valuable tools in keeping track of the high demands in healthcare management, and current movements are aimed at integrating the complex dynamic processes. But they are no “silver bullet” when it comes to handling complexity.

Is there actually something like a “silver bullet” for patient safety? It will be clear to everyone that this can only be a rhetorical question. Download the PDF to learn more about what impact e.g. critical incidence reporting systems and simulation training may have in this context

Updated ISO 80601-2-13 - Reducing the risk of potentially fatal hose mismatches

In recent years, an increasing number of serious cases of misconnected patient ventilation hoses have been reported in Germany and other European countries. Even though this problem occurs rarely we must try to avoid it. The upcoming ISO 80601-2-13 implements new technical controls that aim at minimising the risk for hose misconnections. This will affect hospitals in all countries in which this standard is effective.