Presentation
A Modified Delphi Approach to Patient Safety Challenges in Mexico: An In-Depth Analysis of the Largest Global Cluster of Perioperative Adverse Events
DescriptionAnesthesia plays a pivotal role in modern surgical practice in ensuring patient comfort and pain relief and in maintaining safety during invasive procedures. In developed countries, advancements in anesthesia technology and protocols have reduced anesthesia-related mortality to approximately 1 in 10,000 patients. However, in less developed regions, mortality rates reach alarming levels as high as 51 per 10,000 patients, due to inadequate monitoring, lack of preparation, and insufficient training among anesthesia providers (Braz, 2009). This stark contrast underscores the critical need for targeted safety interventions and continuous improvements of anesthesia practices worldwide.
Between November 2022 and May 2023, two clusters of fungal meningitis outbreaks linked to neuraxial anesthesia administration occurred in Mexico. These outbreaks were devastating, leading to 115 confirmed cases and 48 deaths primarily due to a resistant strain of Fusarium Solani (García-Rodríguez, 2024). The affected patients exhibited severe neurological symptoms, and many suffered from complications such as cerebral strokes and coma. The outbreaks exposed vulnerabilities in infection control and anesthesia safety protocols, particularly in regions with insufficient healthcare infrastructure. These incidents emphasize the need for robust safety measures and a deeper investigation into systemic deficiencies in anesthesia practices.
Recognizing the public health ramifications of the fungal meningitis outbreaks, the Mexican Federation of Colleges of Anesthesiology (FMCA) established the Patient Safety Taskforce. The taskforce convened bi-weekly meetings aiming to address the outbreak comprehensively. These meetings included patient and family interviews, case data reviews, stakeholder identification, news monitoring, and analysis of ongoing FMCA research projects. Outcomes from these projects including research, training, public advocacy including a systematic review of meningitis outbreaks linked to spinal anesthesia, lecture series on healthcare incident analysis frameworks, and sessions on quality improvement and root cause analysis of perioperative adverse events—were shared to inform participants and support the Delphi discussions.
The taskforce conducted a Delphi consensus exercise to systematically identify and prioritize deficiencies in anesthesia administration contributing to patient harm. This approach was chosen to harness a broad array of expert opinions and insights tailored to the local Mexican context.
The process included 42 experts—including anesthesiologists, surgeons, nurses, patient safety advisors, and healthcare executives —the taskforce brought together a diverse group selected for their expertise in anesthesia and surgical safety. The study was conducted in two phases: (1) a survey and thematic analysis for collecting both qualitative and quantitative data, and (2) a modified Delphi consensus process to iteratively achieve agreement on key deficiencies. The survey was designed to identify operational and human factors shortcomings in anesthesia safety. The Delphi process was conducted through a series of online meetings, where survey findings were discussed and refined, with the discussions guided by four international patient safety researchers serving as consultants.
The study’s findings are based on input from 37 participants, representing various clinical roles, including anesthesiologists, operating room nurses, and surgeons from the public and private health sectors in Mexico. The survey identified 102 key data points, which were organized into 15 topics under four major themes: insufficient infection control, lack of resources, inadequate training, and broader systemic challenges such as corruption and improper medication storage. These findings were instrumental in understanding the wide range of issues affecting anesthesia safety in Mexico.
Further refinement of these findings was achieved through the Delphi consensus rounds in February 2024. During these rounds, experts agreed on the most critical deficiencies, such as inadequate monitoring during anesthesia, failure to follow infection control protocols, and the prevalence of counterfeit medications. Additionally, the consensus process brought to light new issues, including corruption and the effects of healthcare underfunding, which were identified as significant operational challenges.
The results of this study have significant implications for enhancing patient safety in Mexico. By engaging experts from diverse fields and employing a structured consensus approach, grounded in sound human factors theory, the taskforce identified critical deficiencies that could be targeted for improvement. The insights gained from this study will guide healthcare providers, policymakers, and researchers in crafting strategies to enhance anesthesia safety, particularly in resource-limited environments like Mexico. The ultimate objective is to develop resilient healthcare systems that can adapt to emerging challenges and reduce the risk of adverse outcomes during anesthesia.
This study reports on the largest cluster of neuraxial adverse events and highlights the importance of context-specific and human factors sound interventions to improve anesthesia safety in developing regions. The stark disparities in anesthesia-related mortality between developed and less-developed countries underscore the need for systemic improvements in monitoring, infection control, and provider training. The fungal meningitis outbreaks in Mexico are a stark reminder of the healthcare system's vulnerabilities and the pressing needs for ongoing quality improvement in anesthesia practices. Collaborative efforts like the FMCA’s consensus exercise are vital in building healthcare systems that are resilient and better equipped to ensure patient safety during anesthesia.
References
Braz, L. G., Braz, D. G., Cruz, D. S. da, Fernandes, L. A., Módolo, N. S. P., & Braz, J. R. C. (2009). Mortality in Anesthesia: A Systematic Review. Clinics, 64(10), 999–1006. https://doi.org/10.1590/S1807-59322009001000011.
García-Rodríguez, G., Duque-Molina, C., Kondo-Padilla, I., Zaragoza-Jiménez, C. A., González-Cortés, V. B., Flores-Antonio, et al. (2024). Outbreak of Fusarium Solani Meningitis in Immunocompetent Persons Associated with Neuraxial Blockade in Durango, Mexico, 2022-2023. Open Forum Infectious Diseases, 11(2), ofad690. https://doi.org/10.1093/ofid/ofad690
Between November 2022 and May 2023, two clusters of fungal meningitis outbreaks linked to neuraxial anesthesia administration occurred in Mexico. These outbreaks were devastating, leading to 115 confirmed cases and 48 deaths primarily due to a resistant strain of Fusarium Solani (García-Rodríguez, 2024). The affected patients exhibited severe neurological symptoms, and many suffered from complications such as cerebral strokes and coma. The outbreaks exposed vulnerabilities in infection control and anesthesia safety protocols, particularly in regions with insufficient healthcare infrastructure. These incidents emphasize the need for robust safety measures and a deeper investigation into systemic deficiencies in anesthesia practices.
Recognizing the public health ramifications of the fungal meningitis outbreaks, the Mexican Federation of Colleges of Anesthesiology (FMCA) established the Patient Safety Taskforce. The taskforce convened bi-weekly meetings aiming to address the outbreak comprehensively. These meetings included patient and family interviews, case data reviews, stakeholder identification, news monitoring, and analysis of ongoing FMCA research projects. Outcomes from these projects including research, training, public advocacy including a systematic review of meningitis outbreaks linked to spinal anesthesia, lecture series on healthcare incident analysis frameworks, and sessions on quality improvement and root cause analysis of perioperative adverse events—were shared to inform participants and support the Delphi discussions.
The taskforce conducted a Delphi consensus exercise to systematically identify and prioritize deficiencies in anesthesia administration contributing to patient harm. This approach was chosen to harness a broad array of expert opinions and insights tailored to the local Mexican context.
The process included 42 experts—including anesthesiologists, surgeons, nurses, patient safety advisors, and healthcare executives —the taskforce brought together a diverse group selected for their expertise in anesthesia and surgical safety. The study was conducted in two phases: (1) a survey and thematic analysis for collecting both qualitative and quantitative data, and (2) a modified Delphi consensus process to iteratively achieve agreement on key deficiencies. The survey was designed to identify operational and human factors shortcomings in anesthesia safety. The Delphi process was conducted through a series of online meetings, where survey findings were discussed and refined, with the discussions guided by four international patient safety researchers serving as consultants.
The study’s findings are based on input from 37 participants, representing various clinical roles, including anesthesiologists, operating room nurses, and surgeons from the public and private health sectors in Mexico. The survey identified 102 key data points, which were organized into 15 topics under four major themes: insufficient infection control, lack of resources, inadequate training, and broader systemic challenges such as corruption and improper medication storage. These findings were instrumental in understanding the wide range of issues affecting anesthesia safety in Mexico.
Further refinement of these findings was achieved through the Delphi consensus rounds in February 2024. During these rounds, experts agreed on the most critical deficiencies, such as inadequate monitoring during anesthesia, failure to follow infection control protocols, and the prevalence of counterfeit medications. Additionally, the consensus process brought to light new issues, including corruption and the effects of healthcare underfunding, which were identified as significant operational challenges.
The results of this study have significant implications for enhancing patient safety in Mexico. By engaging experts from diverse fields and employing a structured consensus approach, grounded in sound human factors theory, the taskforce identified critical deficiencies that could be targeted for improvement. The insights gained from this study will guide healthcare providers, policymakers, and researchers in crafting strategies to enhance anesthesia safety, particularly in resource-limited environments like Mexico. The ultimate objective is to develop resilient healthcare systems that can adapt to emerging challenges and reduce the risk of adverse outcomes during anesthesia.
This study reports on the largest cluster of neuraxial adverse events and highlights the importance of context-specific and human factors sound interventions to improve anesthesia safety in developing regions. The stark disparities in anesthesia-related mortality between developed and less-developed countries underscore the need for systemic improvements in monitoring, infection control, and provider training. The fungal meningitis outbreaks in Mexico are a stark reminder of the healthcare system's vulnerabilities and the pressing needs for ongoing quality improvement in anesthesia practices. Collaborative efforts like the FMCA’s consensus exercise are vital in building healthcare systems that are resilient and better equipped to ensure patient safety during anesthesia.
References
Braz, L. G., Braz, D. G., Cruz, D. S. da, Fernandes, L. A., Módolo, N. S. P., & Braz, J. R. C. (2009). Mortality in Anesthesia: A Systematic Review. Clinics, 64(10), 999–1006. https://doi.org/10.1590/S1807-59322009001000011.
García-Rodríguez, G., Duque-Molina, C., Kondo-Padilla, I., Zaragoza-Jiménez, C. A., González-Cortés, V. B., Flores-Antonio, et al. (2024). Outbreak of Fusarium Solani Meningitis in Immunocompetent Persons Associated with Neuraxial Blockade in Durango, Mexico, 2022-2023. Open Forum Infectious Diseases, 11(2), ofad690. https://doi.org/10.1093/ofid/ofad690
Authors
Event Type
Oral Presentations
TimeTuesday, April 12:37pm - 3:00pm EDT
LocationQueens Quay
Patient Safety and Research Initiatives (PS)