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Website Review

Anonymous Critical Incidents Reporting System (CIRS©)

Toronto, Ontario

http://www.medana.unibas.ch/ENG/CIRS/Cirs.htm

Cirs is an international anonymous critical incident reporting system run by the Department of Anaesthesia, University of Basel, Switzerland. Motivated by the Australian-Incident-Monitoring-Study (AIMS) the authors decided to create an international forum aimed at collecting and distributing anonymously submitted critical incidents from daily anesthetic practice. The system not only allows one to submit critical incidents in a narrative format but also serves as a teaching resource in that one can review adverse clinical experiences by browsing through the case collection. (There are 132 reported critical incidents in the system so far.) As already noted. CIRS submissions are anonymous, raising potential issues about how anonymous information is best handled, especially given that many important details may be missing in submitted reports.

A particularly useful section of the site includes a discussion entitled "Administrative Guidelines for Response to an Adverse Anesthesia Event" based on policies developed at the Department of Anaesthesia, Harvard Medical School. This section of the site should be reviewed whenever a patient has died or has been injured from causes suspected to be related to anesthetic management. (Better still, post a copy in your anesthesia lounge.)

I enjoyed going through the case collection, a surprisingly large number of which were "wrong drug" type errors, such as the anesthesiologist who wondered why his spinal did not work, only to discover that he had administered intrathecal pancuronium instead of intrathecal lidocaine.

I recommend this site to all individuals interested in human error in medicine.

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Doyle, D. J. Search for Related Content PubMed Articles by Doyle, D. J.