Commentary.

Addressing and highlighting the subject of adverse events in healthcare is an obligatory step to establish resolution aiming to evade reoccurrences and thus augment patient safety. Patient safety now-a-days is getting increasing awareness and it is considered one of the human rights issues.[1] The root cause analysis (RCA) of the adverse events must be done within a “no blame and no shame” environment as the final aim is to reply to the “whys” and not the “who”. It can be said with no hesitation that the move on surgical outcome is linked to the advances in anesthesia safety. Extra medical departments are encouraged to ascertain safety strategy within their practice similar to anesthesia.[2] We speak about anesthesia safety as a success accomplishment, because all anesthetic medications and techniques might be associated with severe adverse events, such as anaphylaxis, loss of airways control, cardiovascular instability, respiratory depression, etc…. Anesthesia by itself, does not offer cure. It depends on team work, not to forget that anesthesia is the first medical specialty which developed standards of care through the American Society of Anesthesiologists (ASA) since the 1980,[3] and to have a separate federation for patient safety[4] as an independent body to improve the safety by increasing awareness of anesthesia adverse events and implementing avoidance solutions. Anesthesiologists should work in a noncompetitive environment where the members of the team (Surgeons, nurses and technicians) complete each other and do not compete.Such an attitude enhances the safety culture. The manuscript “Critical Incidents During Anaesthesia in a developing country: A retrospective audit”,[5] is a very good example that there is an increasing awareness among anesthesiologists to improve outcomes by pinpointing the causes and searching for the appropriate strategies considering that such an audit is performed in a developing countries with limited resources. Some studies addressed such critical incidences in a cohort study in a university hospital[6] which is as well a significant sign in that direction, whereas previous reports from the same department confirmed the importance of proper communication among various medical and nursing teams about and with patients to avoid adverse events.[78] The methodology used by the author to identify adverse events was through the medical record retrospective study. Several other methods in developed countries, are approved to identify adverse events, such as administrative data from health insurance company, mortality and morbidity review[8] adverse events (AEs) reporting system, patients complaints, qualitative tools such as focus group discussion with health professionals as well as patients’ direct observation by reference to good practice such as injection safety, central line catheterization. This direct observation by patient or patient advocate is used as a tool to overcome healthcare errors. The availability of other methodologies to identify adverse events is an indicator that there are still a numbers of events that are not yet reported. The author briefly stated the importance of having a well-established system. I would rather go deep on this important factor in avoiding adverse events. Although the anesthesiologist is the service provider at the sharp end, he/she should be backed up with a strong system prioritizing safety at the blunt end, by enhancing patient safety and establishing solid barriers that prevent error, make error visible, and mitigating the effect of error. The author as well stated that human factors such as fatigue, noise or environment are not contributing factors for the events but confirmed that junior residents are involved. Here, we have to relay strictly on the standards of care in anesthesia practice[9] junior anesthesiologists, and anesthesia residents must be strictly supervised and gently brought to the beauty of our specialty. All authors noted that: critical incidents, during elective surgeries on patients with no co morbidity, are more than during operations on patients with co morbidities in emergency surgeries. This is a strong message that vigilance and standards of care must be implemented to all patients regardless of the ASA group, age or type of surgeries. The author concluded by stating the necessity of developing protocols and checklists. The World Health Organization recognized that surgical safety must be prioritized, and developed a surgical safety checklist addressing 19 important items in surgical setting aiming that those 19 items must be treated as a never happened event. Part of the list is forwarded to anesthesia practice. Implementing such a list is not associated either with resources or with time consumption but assures the avoidance of serious adverse events and emphasizeon the importance of training and continuous education.[10]