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  • Implementing human factors in anaesthesia: guidance for clinicians, departments and hospitals (11 January 2023)

    • UK
    • Guides and guidelines
    • Pre-existing
    • Creative Commons
    • No
    • Fiona Kelly, Chris Frerk, Craig Bailey et al
    • 11/01/23
    • Health and care staff, Patient safety leads, Researchers/academics


    This guidance on implementing human factors in anaesthesia has been produced by the Difficult Airway Society and the Association of Anaesthetists. Human factors is an evidence-based scientific discipline used in safety critical industries to improve safety and worker wellbeing; implementing human factors strategies in anaesthesia has the potential to reduce the reliance on exceptional personal and team performance to provide safe and high-quality patient care.

    A three-stage Delphi process was used to formulate a set of 12 recommendations: these are described using a ‘hierarchy of controls’ model and classified into design, barriers, mitigations and education and training strategies.




    1. Design of medical equipment should include input from human factors experts at an early stage. The medical equipment procurement process should include human factors assessments.

    2. Design of drug ampoules and packaging should incorporate human factors principles to optimise readability and reduce the risk of mis-selection: anaesthetists, pharmacists and procurement departments should ensure that these principles are prioritised during their purchasing processes.

    3. Design of safe working environments should incorporate human factors principles. Regular reviews should be carried out to ensure that safety has not been compromised.


    4. Operating theatre list planning and scheduling should include additional time allocated for complex cases and for high turnover lists to enable adequate preparation and reduce time pressures on staff.

    5. Cognitive aids, including algorithms and checklists, should be designed and tested using human factors principles to ensure usability and efficacy.

    6. Non-technical skills can be learned and developed, and should be practised during everyday work to ensure that staff become skilled in their use and are able to use them effectively.


    7. Investigation of critical incidents and adverse events should be performed by teams that include members with human factors training using a human factors investigative tool. Lessons identified should be shared.

    8. Morbidity and mortality meetings should be part of the regular work of all anaesthetic departments and should also include learning from cases that go well. Time within job plans should be allocated to enable staff to prepare for and attend these meetings.

    Education and training

    9. Human factors education and training should be provided at an appropriate level for all anaesthetists and all members of operating theatre teams. It should include the role of good design in healthcare, an appreciation of a systems perspective, the importance of non-technical skills and strategies to improve these.

    10. Non-technical skills training and interprofessional simulation training: Teams that work together should train together. Non-technical skills should be learned during classroom and in-theatre teaching, woven into all anaesthetic workshops and courses and rehearsed during regular interprofessional simulation training. Time and resources should be allocated to allow for this.


    11. Staff wellbeing should be optimised by hospitals and anaesthetic departments by implementing organisational strategies.


    12. Each anaesthetic department should have a human factors lead with an appropriate level of training. Every hospital should have patient safety leads with appropriate training and qualifications; in England, this is already included in Health Education England recommendations.

    Implementing human factors in anaesthesia: guidance for clinicians, departments and hospitals (11 January 2023) https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.15941
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