The Tradition of Anaesthetic Rooms: Best Practice or Patient Risk?

In the United Kingdom (UK), anaesthetic rooms (ARs) are the standard site for induction of anaesthesia. Although advocates of ARs argue that they provide a quiet and comfortable place for patients to be anaesthetised, the competing argument is that ARs create a risk to those patients by transferring them whist they are unconscious and unmonitored. This study focuses on the current use of ARs and the rationale for their inclusion in new theatre design. It investigates decision-making and prioritisation of competing factors in clinical choice. Mixed methods were used to explore perspectives of anaesthetic clinicians and perioperative managers. Two hundred and two consultant anaesthetists from National Health Service Trusts across the East Midlands region of the UK completed an online survey, and 17 perioperative managers were interviewed regarding the incorporation of ARs in theatre design and changing practice. The majority of anaesthetists preferred to induce all types of patients in the AR, except high risk and obese patients. The most important reasons for choosing to induce in the AR were the ‘quiet environment’ and “patient experience’, whereas the least important reasons included ‘patient safety’ and ‘efficiency’. For the respondents who preferred to induce in the theatre the primary reason was ‘patient safety’. Manager interviews revealed their belief that the benefit of ARs is based on perception –not evidence. The research findings question the motives for using the AR for standard anaesthesia provision, as both the daily use of, and design considerations for ARs, seem driven by perception and experience, rather than clear and compelling evidence. Anaesthetic practice in the UK may be operating under the pretences of safety and performance, while carrying on with a traditional way of working which may one-day prove to be an unacceptable risk and investment.