​Patients who receive care from multiple attending anesthesiologists and in-room providers during an operation may have an increased risk of postoperative complications, according to a study published in the January 2016 issue of Anesthesia & Analgesia. The authors evaluated the safety of anesthesia care transitions by analyzing quality improvement and administrative data documenting the number of anesthesia providers involved in operations of 927 patients undergoing elective colorectal surgery in an academic tertiary care center between 2006 and 2010. Of the 927 patients, 530 (57%) received care from only one anesthesiologist, 287 (31%) received care from two anesthesiologists, and 110 (12%) received care from three or more anesthesiologists. A total of 105 complications occurred, with 71 patients (7.7%) experiencing a major complication, including 7 who died; only one patient experienced an intraoperative event. The researchers found that higher numbers of attending anesthesiologists were associated with increased odds of postoperative complication, findings that persisted across multiple data adjustment strategies and sensitivity analyses. In addition, the researchers found that a higher number of in-room providers (e.g., residents, nurse anesthetists) was also associated with an increased risk of adverse postoperative outcomes. An accompanying editorial by Meghan B. Lane-Fall, MD, MSHP, states that, although several recent studies have linked intraoperative handoffs to an increased risk of patient mortality and major morbidity, minimizing or eliminating handoffs altogether is not feasible "for both regulatory and human factors reasons." According to Lane-Fall, "Given the impracticality of eliminating handoffs from anesthetic practice, we are now challenged with figuring out how to keep the good aspects of handoffs, dispense with the bad, and maintain the anesthesiologist's position as a leader in patient safety."

HRC Recommends: Studies have shown that patient harm and liability claims and malpractice lawsuits are attributable, at least in part, to communication failures and breakdowns. The operating room (OR), in particular, is a high-risk environment in which effective communication is crucial to preventing adverse events. Ensuring adequate staffing in the OR and providing interdisciplinary training in effective communication at anesthesiology handoffs may reduce the risk of harm.