The Nordic perioperative and intensive care registries-Collaboration and research possibilities.

BACKGROUND: The Nordic perioperative and intensive care registries have been built up during the last 25 years to improve quality in intensive and perioperative care. We aimed to describe the Nordic perioperative and intensive care registries and to highlight possibilities and challenges in future research collaboration between these registries. MATERIAL AND METHOD: We present an overview of the following Nordic registries: Swedish Perioperative Registry (SPOR), the Danish Anesthesia Database (DAD), the Finnish Perioperative Database (FIN-AN), the Icelandic Anesthesia Database (IS-AN), the Danish Intensive Care Database (DID), the Swedish Intensive Care Registry (SIR), the Finnish Intensive Care Consortium, the Norwegian Intensive Care and Pandemic Registry (NIPaR), and the Icelandic Intensive Care Registry (IS-ICU). RESULTS: Health care systems and patient populations are similar in the Nordic countries. Despite certain differences in data structure and clinical variables, the perioperative and intensive care registries have enough in common to enable research collaboration. In the future, even a common Nordic registry could be possible. CONCLUSION: Collaboration between the Nordic perioperative and intensive care registries is both possible and likely to produce research of high quality. Research collaboration between registries may have several add-on effects and stimulate international standardization regarding definitions, scoring systems, and benchmarks, thereby improving overall quality of care.

[Infusion pumps and patient safety]. / Infusionspumper og patientsikkerhed.

INTRODUCTION: Infusion pumps are important clinical tools where controlled and precise infusions are needed. However, there are a number of potential risks for patient safety in their use: There is a risk of free-flow, i.e. an uncontrolled infusion that may have fatal consequences to the patient; staff is often poorly trained to use these devices, and often the devices themselves do not offer much support in this regard. MATERIAL AND METHODS: Technical and organisational data regarding the use of infusion pumps in the hospitals of the Copenhagen Hospital Corporation (CHC) were collected and analysed. Critical incidents reported to the CHC Incident Database were analysed. RESULTS: Forty-two different infusion pumps are in use by the five CHC hospitals. There was a total of 919 volumetric infusion pumps, 71% having set-based free-flow protection. Critical incidents were in 40% of cases caused by user-error, the most common being setting an incorrect infusion rate. Discontinuation of the infusion was reported in 27% of incident reports, the causes being disconnection or kinking of the infusion line; this resulted in two cases of awareness under anaesthesia. CONCLUSION: Centralising the decision process for procurement and establishing a central library of standardised equipment might well reduce patient safety risks and any under-use of equipment. Usability testing prior to procurement decisions is vital; such testing should be performed by validated methods and not simply by putting the pumps to test in a clinical setting. More knowledge about user-friendly designs of medical equipment is needed.

[Assessment of physicians' competence. The continuous professional development]. / Kompetenceevaluering af speciallaeger. Den kontinuerlige professionelle udvikling.

Several stakeholders now request some sort of continuous assessment of physician performance. In the assessment of physicians it must be acknowledged that physicians often work in teams and systems, rendering it impossible to attribute quality of practice to a single person. The challenge is to design a concept that is a meaningful contribution to the development of quality of practice. There is a need to rethink the traditional discourse known from undergraduate and postgraduate specialist educations when applying concepts of assessment to the continuous professional development.