Author(s): Howells M.; Burford P.
Source: Anaesthesia; Jul 2019; vol. 74 ; p. 33
Publication Date: Jul 2019
Publication Type(s): Conference Abstract
Available at Anaesthesia – from Wiley Online Library Full Collection
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Abstract:Frances Cappuccini was a school teacher who in October 2012 had a postpartum bleed following a caesarean section. She was taken back to theatre without adequate resuscitation by a junior anaesthetist. Postoperatively the patient died of a severe mixed metabolic and respiratory acidosis following removal of the patient’s endotracheal tube without adequate correction of the patient’s physiology. The coroner was concerned during the subsequent investigation that it was almost impossible to determine who was supervising the trainee and who was ultimately responsible for the patient’s care. It has been proposed that the ‘Cappuccini test’  (Fig. 1), may help ensure that supervision gaps do not arise within a department and that trainees have immediate access to either consultant advice or assistance. Methods We performed an audit of 88 theatre lists, selected at random to see what supervision arrangements were in place and sought to discover if trainees were able to contact their supervisors in the event of an emergency. Additionally we audited whether consultants were aware of what was happening on lists they were supervising and whether Aintree Hospital was compliant with the proposed ‘Cappuccini test’ . Results At Aintree hospital, every patient had an assigned consultant and no gaps in supervision arrangements were found. Trainees, however, were not directly supervised in 30% of lists audited. Of the unsupervised trainees, 100% of trainees knew who was supervising them, but only 85% knew where their supervising consultant was to make contact with them. In 28% of audited cases, the consultant was not in a location expected by the trainee and therefore not immediately available for assistance. Discussion Anaesthetic complications can occur at any time during anaesthesia, often at short notice and with little warning. It is difficult to know how much supervision is warranted to strike a balance between patient safety and allowing trainee development. There is little guidance issued advising supervision expectations; however, instant access to consultant advice and assistance should be something that patients undergoing anaesthesia should be expected to receive. It is clear that whilst supervision arrangements are generally good in anaesthesia, there are occasions where access to consultant assistance is patchy. This audit highlights areas for improvement and development to ensure best practice is maintained and supervision of anaesthesia is more consistent. (Figure Presented).