Claims analysis identifies causes of OR fires
Electrocautery-induced fires during monitored anesthesia care were the most common cause of operating room (OR) fire claims, according to a recent study which analyzed closed malpractice claims in the American Society of Anesthesiologists Closed Claims Database since 1985.1 Other key findings:
• Payments to patients were more often made in fire claims, but payment amounts were lower (median $120,166) compared to nonfire surgical claims (median $250,000).
• Electrocautery-induced fires increased over time to 4.4% of claims between 2000 and 2009.
• Most (85%) electrocautery fires occurred during head, neck, or upper chest procedures.
• Oxygen was administered via an open delivery system in all high-risk procedures during monitored anesthesia care. In contrast, alcohol-containing prep solutions and volatile compounds were present in only 15% of OR fires during monitored anesthesia care.
“Perhaps the most surprising finding is that the use of alcohol-based prep solutions was not the most common cause for these fires,” says Sanjay M. Bhananker, MD, FRCA associate professor in the Department of Anesthesiology and Pain Medicine at Harborview Medical Center in Seattle.
Recognition of the “fire triad” — oxidizer, fuel, and ignition source — and particularly the critical role of supplemental oxygen by an open delivery system during use of the electrocautery is crucial to prevent OR fires, concluded the researchers. To reduce liability, Bhananker says physicians should follow recommendations on evaluating fire risk and have an appropriate fire prevention plan for high-fire risk procedures. (See resources at end of article for more information.)
“Continuing education of OR personnel and development and implementation of fire prevention protocols is crucial,” he says. “This will likely lead to reduction in OR fires and associated liability.”
Reference
1. Mehta S, Bhananker S, Posner KL, et al. Operating room fires: A closed claims analysis. Anesthesiology 2013; 118(5):1133–1139.
Source/Resources
• Sanjay M. Bhananker, MD, FRCA, Department of Anesthesiology and Pain Medicine, Harborview Medical Center, Seattle. Phone: (206) 744-3059. Fax: (206) 744-8090. Email: [email protected].
• The American Society of Anesthesiologists’ (ASA) updated Practice Advisory for the Prevention and Management of Operating Room Fires, which gives recommendations to identify the situations conducive to fire, prevent the occurrence of OR fires, and reduce adverse outcomes associated with OR fires, is available at http://bit.ly/19KRwim. To view an ASA closed claim analysis, “On-Patient Fires: Prevention during Monitored Anesthesia Care,” go to http://bit.ly/YQIhvi.
• Educational videos for preventing surgical fires from the U.S. Food and Drug Administration, titled Surgical Fires: How They Start and How to Prevent Them, Prevention of Surgical Fires, Prevention and Management of Operating Room Fires, and FDA Patient Safety News: Preventing Fires in the Operating Room are available at http://1.usa.gov/16vCjp3.
• The Anesthesia Patient Safety Foundation’s 18-minute video, Prevention and Management of Operating Room Fires, can be viewed at http://bit.ly/k3KseQ. To request a free copy of the DVD, fill out an online form at http://bit.ly/ewOGfP. To request multiple copies, send an email to [email protected].
Electrocautery-induced fires during monitored anesthesia care were the most common cause of operating room (OR) fire claims, according to a recent study which analyzed closed malpractice claims in the American Society of Anesthesiologists Closed Claims Database since 1985.1You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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