Falls from the OR or Procedure Table: Claims Analysis Identifies Potential Factors
September 27, 2017 | Strategic Insights for Health System
Falls from the operating room (OR) or procedure table during anesthesia care are rare but can have “medical, professional, legal, and financial consequences," write the authors of a special article in the September 2017 issue of Anesthesia and Analgesia. The authors identified 21 relevant claims since 2000 in the American Society of Anesthesiologists' (ASA) Closed Claims Project database (1.2% of claims) and 10 relevant reports since 1987 in the database of an anesthesiology-specific liability insurer (0.07%). The falls involved a variety of procedures, both inpatient and outpatient, and a variety of anesthetic techniques. The authors identified factors that may have contributed to the falls. Patient attributes that may have contributed include obesity, older age, nonsupine positioning (particularly lateral), sedation or altered level of consciousness, and agitation during anesthesia induction or emergence. Provider factors that may have contributed include distraction, shifting of attention from the patient to other tasks, belief that others were securing the patient, and production pressures. Factors related to the OR table included use of an unfamiliar table, mechanical table failures or improper use, extreme positions, lack or inadequate use of safety restraints, unlocked wheels, and tipping of the table. The authors suggest that anesthesiologists ensure familiarity with table controls and weight limits and selection of an appropriate table for each case, considering the procedure and individual patient. They also emphasize the importance of properly securing the patient at all relevant times (e.g., during table movements) and propose that anesthesiologists coordinate the positioning and movement of obese patients, using multiple individuals and extra “posts" when necessary. The authors underscore the need for vigilance, especially during sedation or times when patients have altered levels of consciousness.