Engaging in risky business: is it time to rethink risk tolerance in anaesthesia?

In this issue of the British Journal of Anaesthesia, Greig and colleagues¹ describe a new study examining risk tolerance amongst a large and diverse group of anaesthetists from across a single National Health Service Trust. Using a validated electronic questionnaire, the authors presented a group of anaesthetists with 11 risky situations and queried respondents as to whether they would proceed with the procedure or not (a go/no-go decision). Importantly, all of the scenarios were drawn from previous instances where a critical incident had occurred and been reported. Among their key findings, the authors reported that a consultant was significantly more likely to proceed with a given scenario than a trainee. Perhaps even more striking was the finding that in no one scenario was there absolute agreement over whether to proceed or not. Even in situations where national guidelines clearly suggest a procedure should be cancelled (i.e. a faulty gas analyser), several individuals responded that they would proceed. Overall, the authors found wide variability in what anaesthetists consider either acceptable or professional behaviour. One might expect that if the study were expanded to include other trusts, or even anaesthetists from other countries, this variability would be likely to persist.

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