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In the UK, obstetric surgery is commonly performed with the patient awake and her partner present. Patient expectations are high. Even under high quality regional anaesthesia, non‐painful sensation may occur. This and other contentious issues must be discussed before surgery. Legal proceedings against obstetric anaesthetists are rare, but may arise many months later. Accurate contemporaneous notes are essential. The quality of notekeeping was audited for 50 Caesarean sections. A redesigned anaesthetic chart with prompts for key information was introduced and the audit repeated. There were significant improvements in documenting the pre‐operative discussion of: intra‐operative sensation; conversion to general anaesthesia; post‐dural puncture headache; suppositories; neuraxial opiate‐induced itch. Records of pain free operations; the presence or absence of nerve root pain; and the timing of events leading to delivery were significantly increased. This audit suggests that an anaesthetic chart with specific prompts improves the documentation of medico‐legally relevant information.

For this study 334 patients during their stay in the recovery room were assigned to the following groups: ‘comfortable’, in ‘pain’ and in ‘severe pain’. Fourteen per cent of patients awoke from anaesthesia in ‘pain’ and 10% were discharged to the ward in ‘pain’. Thirty‐seven per cent of patients using patient‐controlled analgesia (PCA) in the recovery room were discharged in ‘pain’; 63% of these patients had neither been prescribed nor given a ‘loading dose’ in the recovery room. Forty‐eight per cent of patients receiving sole intramuscular opioid analgesia were discharged in ‘pain’. Ninety per cent who received nurse‐administered ‘prn’ intravenous bolus opioids were discharged ‘comfortable’. An algorithm was therefore developed for the administration of loading doses of intravenous opioids in the recovery unit to be used by recovery nursing staff prior to PCA or other analgesic methods. An early re‐audit established that the algorithm became widely adopted by anaesthetists, was safe and produced comparable discharge pain scores.

The pre‐operative anaesthetic records of 195 patients were analysed for the presence of 12 agreed core items of pre‐operative assessment. This study showed that anaesthetists recorded 26.8 per cent of this information. In up to one‐third of patients the following were recorded: smoking history, family history, gastro‐oesophageal reflux, airway assessment, dental assessment, chest examination, heart‐sounds and blood pressure. Previous anaesthesia, drug history and allergies were recorded in one to two‐thirds of patients. Past medical history was recorded in over two‐thirds of patients. With a view to improving the level of record‐keeping, a formatted, pre‐printed pre‐operative assessment record was introduced into practice and two months later the audit was repeated. A small but non‐significant improvement in record keeping was observed. An argument is made for the introduction of an interdisciplinary, unified anaesthetic pre‐operative record.

THE continuance of war into the New Year proves again the fatuousness of prophecy which had assured us of peace, or at least the cessation of hostilities, by Christmas. We have to face now what must be another year of conflict, unless miracles occur as they sometimes do in war, and thus the postponement of many of the plans that the Library Association and a great many other bodies and persons have been making; but we must not offend by prophesying. At this time a glance back on the record of 1944 is justifiable and may be salutary.

States that the traditional model of obstetricians seeing all pregnant women and directing their care is changing due to a recognised need for anaesthetists to provide, good, high‐quality information on pregnant women and the development of midwifery‐led care. Presents the “pathway” of care which has undergone a 12‐month study period involving 3,500 pregnant women. Concludes that the results from the study reveal important gaps in the service, but that the pathway of care has produced benefits for all professional groups involved.

The purpose of this article is to examine the hypothesis that ‘classified schedules of features, with specific/generic relationships, are of value in feature‐card indexing.’ The data in support of the hypothesis has been drawn from experience gained in the construction and use of a feature‐card index designed for anaesthetics literature. This index has already been described in detail elsewhere; but to make this article comprehensible it is necessary after outlining the problem of the information explosion in medicine, and in anaesthesia in particular, to give a brief account of the development and structure of this feature‐card index.

The purpose of the present study is to introduce the elements characterising the work context of high responsibility teams (HRTs) operating in high reliability contexts such as medicine or aviation. Based on these elements, the authors reflected on the function of teamwork in these contexts, which is strongly dominated by a notion of flexibility under complexity, based on the technical, normative, and governance dimensions of teamwork.

Problem‐centred interviews (n=11) based on semi‐structured guidelines were conducted. Subsequently, a survey was conducted using a questionnaire inventory in six different HRT work contexts (n=551).

The interviews and survey results show significant differences regarding, for example, hierarchy or stress posed on the HRTs. However, they also demonstrate relevant similarities regarding, for instance, dimensions of complexity occurring in the teamwork contexts. Both differences and similarities influence how the support systems of the teamwork dimensions should be set up.

The study provided an excellent overview of similar and differing characteristics of the work context of different HRTs. However, it represents six specific HRTs and might not be generalisable to teams in other high reliability organisations, such as in the energy sector.

It is recommended that the characteristics of work contexts in HRTs should be taken into account in order to set up support systems of teamwork dimensions that enable teams to transfer the prevalent safety discourse into safety practice.

The innovative approach, which combines qualitative and quantitative data, provided insights that can be used to support team functioning in the team's specific work context.

The purpose of this paper is to explore the perceptions of operating room staff towards the use of the World Health Organization Surgical Safety Checklist in a tertiary hospital in Jordan.

This was a qualitative descriptive study. Semi-structured interviews were conducted with a purposeful sample of 21 healthcare staff employed in the operating room (nurses, residents, surgeons and anaesthesiologists). The interviews were conducted in the period from October to December 2021. Thematic analysis was used to analyse the data.

Three main themes emerged from data analysis namely compliance with the surgical safety checklist, the impact of surgical safety checklist, and barriers and facilitators to the use of the surgical safety checklist. The use of the checklist was seen as enabling staff to communicate effectively and thus to accomplish patient safety and positive outcomes. The perceived barriers to compliance included excessive workload, congestion and lack of training and awareness. Enhanced training and education were thought to improve the utilization of the surgical safety checklist, and help enhance awareness about its importance.

While steps to utilize the surgical safety checklist by the operation room personnel may seem simple, the quality of its administration is not necessarily robust. There are several challenges for consistent, complete and effective administration of the surgical safety checklist by the surgical team members. Healthcare managers must employ interventions to eliminate barriers to and offer facilitators of adherence to the application of the surgical safety checklist, therefore promoting quality healthcare and patient safety.

This study seeks to challenge the notions of the standardized care pathway and patient‐centred care, both of which provide only a partial view of care as a complex system. In exploring and contrasting the care pathway protocol and an actual care pathway, the study aims to analyze the conceptualizations of care that actors involved in the actual care pathway have. The study makes suggestions on how to expand care pathways and thereby improve patient care.

A care pathway protocol is contrasted with the actual care pathway of a patient at a university hospital in Finland. Observational ethnography is combined with a narrative approach and activity‐theoretical ideas.

The study depicts the gap between the care pathway protocol and an actual care pathway. The actual care pathway, rather than being a clear‐cut process, is ruptured and unpredictable. The conceptualizations of care (i.e. care‐objects) held by the doctors, nurses and the patient were fragmented and clashed in their practical work activity. The main message to hospital management is that in order to expand care pathways, the multiple care‐objects need to be placed in constructive interplay.

A single actual care pathway is presented and the results are interpreted accordingly.

The study explores the idea of a care pathway and patient‐centred care in the analysis of care‐objects. A new discursive model is introduced that places different care‐objects into interplay and opens up the possibilities for the expansion of care pathways.

The high variability in cardiac surgery length – is one of the main challenges for staff managing productivity. This study aims to evaluate the impact of six interventions on open‐heart surgery operating theatre productivity.

A discrete operating theatre event simulation model with empirical operation time input data from 2,603 patients is used to evaluate the effect that these process interventions have on the surgery output and overtime work. A linear regression model was used to get operation time forecasts for surgery scheduling while it also could be used to explain operation time.

A forecasting model based on the linear regression of variables available before the surgery explains 46 per cent operating time variance. The main factors influencing operation length were type of operation, redoing the operation and the head surgeon. Reduction of changeover time between surgeries by inducing anaesthesia outside an operating theatre and by reducing slack time at the end of day after a second surgery have the strongest effects on surgery output and productivity. A more accurate operation time forecast did not have any effect on output, although improved operation time forecast did decrease overtime work.

A reduction in the operation time itself is not studied in this article. However, the forecasting model can also be applied to discover which factors are most significant in explaining variation in the length of open‐heart surgery.

The challenge in scheduling two open‐heart surgeries in one day can be partly resolved by increasing the length of the day, decreasing the time between two surgeries or by improving patient scheduling procedures so that two short surgeries can be paired.

A linear regression model is created in the paper to increase the accuracy of operation time forecasting and to identify factors that have the most influence on operation time. A simulation model is used to analyse the impact of improved surgical length forecasting and five selected process interventions on productivity in cardiac surgery.