title: Anesthesia and patient safety: have we reached our limits?
abstract: OBJECTIVE
  To provide recent evidence of safety in anesthesia and appraise the role of established tools of safety improvement in anesthesia practice.
  
  
  RESULTS
  The current incidence of minor events or complications during anesthesia is estimated at 18-22%, for severe complications 0.45-1.4%, and for mortality of 1: 100 000. Evidence suggests that despite such low complication rates, further improvements can still be made by addressing systemic factors which are known to set up conditions for adverse events. In particular, improvements can be made in the areas of drug errors, and inadequate or lack of communication between different clinical teams during the process of handovers. In addition, the evidence is growing which highlights the importance of established tools such as critical incident reporting, quality management using plan-do-check-act cycles, use of checklists and use of simulation in training clinical staff in the areas of nontechnical skills.
  
  
  CONCLUSIONS
  Anesthesia is one of the safest clinical specialties and remains at the top among leaders of patient safety. This review provides evidence for the areas in which further progress can be made, and usefulness of certain tools, such as critical incident reporting, checklists, plan-do-check-act cycles and simulation, can be used for continued improvements.
authors.affiliation: Department of Anaesthesia and Intensive Care, Regional Hospital, Maennedorf, Zurich, Switzerland. s.staender@spitalmaennedorf.ch
authors.forename: Sven E A
authors.initials: SE
authors.lastname: Staender
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Mahajan
mesh_terms: D000758:Anesthesia / Q000009:adverse effects* / Q000401:mortality; D057189:Checklist; D006801:Humans; D007345:Insurance Claim Review; D008508:Medication Errors; D010361:Patients; D058996:Quality Improvement; D012449:Safety; D017751:Safety Management / Q000592:standards* / Q000639:trends