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Safer Surgery part 43. There have been few research investigations into how highly trained doctors and nurses work together to achieve safe and efficient anaesthesia and surgery. While there have been major advances in surgical and anaesthetic procedures, there are still significant risks for patients during operations and adverse events are not unknown. Due to rising concern about patient safety, surgeons and anaesthetists have looked for ways of minimising adverse events. | 394 Safer Surgery Figure 23.3 Comparison of task omission among those tasks shown in Table 23.1 Video analysis provided other evidence of increased time stress involved in emergency intubations and the additional shortcuts task shedding and task deferral that can result for example fewer physiological monitors were used p 0.05 unpaired t-test during emergency and semi-emergency than during elective intubations despite the same monitoring systems being present in all locations where video recording occurred Table 23.2 . A major difference was in exhaled carbon dioxide monitoring. Time to achieve various landmarks in the task model for intubation showed that pre-oxygenation was shorter duration between completion of tracheal tube insertion and monitoring of exhaled CO2 was almost four times longer in emergency than elective intubation Table 23.3 . Table 23.2 Monitors used number of patients of total n 48 at each level of airway management task urgency. Emergency 10 mins after admission semi-emergency 10-60 mins after admission and elective 1 hour after admission Elective Semi-emergency Emergency SaO2 12 80 15 100 15 83 ETCO2 7 47 9 60 4 22 BP 13 87 15 100 14 78 ECG 15 100 15 100 17 94 p 0.05 unpaired t-test emergency v. elective and semi-emergency SaO2 oxygen saturation ETCO2 end-tidal CO2 BP blood pressure ECG electocardiogram Measuring the Impact of Time Pressure on Team Task Performance 395 Table 23.3 Task durations of intubation events. Mean and standard error of duration in secs of events in the intubation sequence among 11 elective and 12 emergency tracheal intubation Event Emergency intubation Elective intubation Preoxygenation before anaesthesia 234 12.5 92 6.0 Preoxygenation before DL 310 10.2 145 6.1 Duration of DL 31 2.1 32 2.4 Duration DL to ventilate 41 2.5 30 1.3 Duration Ventilation to listen to chest 10 0.7 38 5.9 Duration Ventilation to ETCO2 observe 52 5.3 205 16.8 significant at p 0.05 Commentary Numerous studies show that under time pressure .
