Patient safety in the COVID era; an update from the SALG-BIDMC Safety Scholars

The Safe Anaesthesia Liaison Group (SALG) offers scholarships at Boston’s Beth Israel Deaconess Medical Center (BIDMC) for trainees with an interest in patient safety. This two-year fellowship allows SALG-BIDMC scholars to complete a fully-funded Master’s degree in Healthcare Quality and Safety (MHQS) at Harvard University and work clinically at BIDMC. We, the current scholars (Liana Zucco, ST6, London; Matthew Needham, ST7, Yorkshire), provide an update on our experiences.

LZ: Predictably my inaugural fellowship year was dominated by COVID, as Massachusetts coped with its first surge in the spring. While elective operating activity was suspended, I played a key role in developing standard operating procedures and sitespecific peri-operative workflows to care for COVID patients requiring surgery [1]. These urgent changes were implemented through the use of ‘just-in-time’ in-situ simulation, which facilitated successful training for over 400 peri-operative staff members across the network. This work was well received by peri-operative staff, and led to further multi-disciplinary collaborative efforts across the hospital to standardise COVID care in remote areas such as endoscopy [2], interventional radiology and obstetrics [3]. The skills learnt on the MHQS course such as process mapping, failure modes effect analysis, and change management were therefore put into practice at the earliest opportunity [4].

Beyond COVID, the department of anaesthesia at the BIDMC has an active safety committee, and as quality and safety fellows, we are included as faculty, contributing to weekly anaesthetic morbidity and mortality presentations, and providing training and guidance on root cause analysis to all the anaesthesiology residents who undertake the investigation of a real adverse event. This role reinforces concepts from the safety component of the MHQS, and helps us become proficient in assessing and clarifying systems issues that result in adverse events, and understand how best to develop strategies to mitigate those risks.

The remainder of our non-clinical time is spent engaging in research on safety-related topics, and operational work developing guidelines for the implementation of new devices and initiatives. This work included a retrospective cohort study evaluating the risk of post-operative pulmonary complications using desflurane, resulting in its removal overnight from BIDMC [5]. Further research with a focus on peri-operative quality and safety is ongoing in several areas, for example, the development of accurate safety measures to assess the impact of a change in use of a primary airway device, implementing a framework for multi-disciplinary debriefing after major adverse events in theatre, and the use of team-based in-situ simulation training to assess latent safety hazards in remote sites within the hospital. We are also in the midst of implementing high-flow nasal oxygenation throughout the entire peri-operative service, and are responsible for developing guidelines, educational materials and an operational plan to facilitate its introduction.

The SALG-BIDMC scholarship is a fantastic opportunity for trainees approaching CCT. We have gained skills in research, quality improvement and safety science that we are eager to bring back to our NHS work on return to the UK. Despite the pandemic, Boston has remained a vibrant and dynamic city offering exceptional sites to explore during the changing seasons. We are thankful for all the help given to us by SALG and the BIDMC, who have been generous in providing this opportunity and supportive of all our academic and clinical work.

More information on the scholarship and the Harvard MHQS course can be found on the SAFE website and the Harvard Medical School website.

Liana Zucco
Matthew Needham
SALG-BIDMC Safety Scholars
Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA

Twitter: @lianazucco

References 

1. Anesthesia Patient Safety Foundation. Perioperative considerations for the 2019 novel coronavirus (COVID-19), 2020. https://www.apsf.org/newsupdates/ perioperative-considerations-for-the-2019-novel-coronaviruscovid- 19/ (accessed 5/12/2020). 
2. Feuerstein JD, Levy N, Zucco L, Levy LA, Sawhney M, Ramachandran SK. Management of a COVID-19 patient in the endoscopy suite. VideoGIE 2020; 5: 327–30. 
3. Li Y, Ciampa EJ, Zucco L et al. Adaptation of an obstetric anesthesia service for the SARS-CoV-2 pandemic: description of checklists, workflows and development tools. Anesthesia and Analgesia. 2020 doi:10.1213/ ANE.0000000000005256. 
4. Levy N, Zucco L, Ehrlichman RJ et al. Development of rapid response capabilities in a large COVID-19 alternate care site using failure modes and effect analysis with in situ simulation. Anesthesiology 2020; 133: 985-96. 
5. Zucco L, Santer P, Levy N et al. A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single-centre cohort study. Anaesthesia 2020 doi:10.1111/anae.15203.

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