In-depth analysis of anesthetic mishaps: tools and techniques.

In-depth analysis of an anesthetic mishap requires the acquisition and analysis of a complex body of data. These tasks are facilitated by specific tools and approaches. At the outset, the reviewer should create a registry for documents and seek a factual overview of events. Basic information about case management should be obtained with a structured survey instrument. Critical pieces of information must be explicitly indexed for later examination. Timelines are particularly effective for organizing and displaying key events. The process of data analysis can be expedited by starting with broad concerns and moving to finer distinctions in a stepwise manner. Preparation of a short summary is the first analytic task. Next, the relationships between the injury, the mechanism of injury, and the contributory actions of the caretakers are formally linked as a hypothesis of injury. Finally, each contributory action is examined individually to determine if it represents a deviation from the standard of care. Contradictory information is an expected feature of in-depth analysis. This problem can often be resolved by testing for clinical relevance, identifying obvious inaccuracies, and emphasizing findings from the most reliable sources. Recent work suggests that practicing anesthesiologists can analyze mishaps with a significant degree of interrater reliability. Thus, aggregate data obtained from in-depth analysis may play an increasingly important role in research, risk management, and peer review.