Intended for healthcare professionals

Rapid response to:

Education And Debate

Anaesthesiology as a model for patient safety in health care

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7237.785 (Published 18 March 2000) Cite this as: BMJ 2000;320:785

Rapid Response:

Re: Black boxes in anaesthetics

The concept of "black boxes" in anesthesiology has been discussed in
the professions several times in the past. The Anesthesia Patient Safety
Foundation (U.S.) has been discussing this concept informally, and may
convene more formal meetings on the feasibility of this approach.

However, there are obstacles. Privacy issues are important and have
played a major role in the way that black boxes are used in aviation.
Only the final 30 minutes of cockpit voice data are recorded, and the
cockpit voice recorder is only downloaded if there is an accident. Flight
data recorder data is also carefully guarded and there are strict
limitations on how it can be used.

A problem in anesthesiology is that we often do not know for sure
when an adverse event has occurred until we see how things play out for
hours or days. Also, the number of events that are not "perfect" is very
high. These cannot all be investigated in the way that the NTSB
investigates aircraft accidents in the U.S.

None of these (or the other relevant problems) are insurmountable,
but they ARE difficult problems. Thus, it will not be easy to put into
practice an analog to the aviation system of "black boxes" but I agree
that serious thought should be given to the issue to define the problems
and potential solutions to them.

Competing interests: No competing interests

23 March 2000
David Gaba
Director
Patient Safety Center of Inquiry at VA Palo Alto HCS