Crisis Management In Hospital

Healthcare institutions of today are complex matrix organizations.
Crisis is bound to occur in any complex human endeavour, and healthcare is no exception.
We often encounter crisis while delivering health care. Crisis is more common in area of emergency, critical care and operation theater. Crises are ubiquitous and the costs (human and financial) are substantial.

A "crisis" has been defined as "a turning point" and, in the context of health care, "the point in the course of a disease at which a decisive change occurs, leading either to recovery or to death“

The problem facing the clinician is to detect that a crisis is at hand, to diagnose its underlying cause, and to take the necessary steps to divert the course of the patient’s condition from impending disaster towards recovery. This problem is not always managed adequately, and the consequences of this inadequacy are sometimes tragic.
Why crisis is common in Hospital? :
ØUncertain, dynamic environments.
ØMultiple sources of concurrent information.
ØShifting, ill-defined, or competing goals.
ØIll-structured problems.
ØActions having immediate and multiple consequences.
ØMoments of intense time stress interleaved with long periods of routine activity.
ØSophisticated technologies with many redundancies.
ØComplex and sometimes confusing human-machine interfaces.
ØHigh stakes.
ØMultiple players with differing priorities.
ØA working environment highly influenced by group norms and organisational culture.
ROOT CAUSE ANALYSIS:


MAN RELATED:
Examples-
Air embolisation during withdrawal of central line.
Oesophageal intubation followed by paralysis.
MACHINE RELATED:
Examples-
Massive haematemasis ,aspiration due to non functioning suction machine.
Malfunctioning laryngoscope during intubation.
MATERIAL RELATED:
Example-
Empty oxygen cylinder
Drugs causing life threatening complication
METHODS RELATED:
Example-
Mismatched blood transfusion.
Inadequate management of hypotension/hypoxia.