The ANZTADC project – Information Sheet
www.anztadc.net
Introduction
ANZTADC is the Australian and New Zealand Tripartite Anaesthetic Data Committee. This committee
represents and is funded by three organisations, the Australian Society of Anaesthetists, the New
Zealand Society of Anaesthetists and the Australian and New Zealand College of Anaesthetists. The
committee has developed 'WebAIRS' (web based anaesthetic incident reporting system). This
program is e-Health compliant and can be incorporated into hospital systems to assist anaesthetists
to report, evaluate and receive information regarding anaesthetic incidents. The data recorded is
anonymous, de-identified and protected by the federal health legislation in both Australia and New
Zealand. The incidents recorded in the ANZTADC registry will be analysed and solutions developed to
help prevent similar incidents from recurring in the future. The results and solutions developed as a
result of the analyses will be fed back into the system and so the 'loop can be closed’ as part of a
quality improvement system.
This document shows how to login, how to record an incident, and how to register yourself or
register a hospital.
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Logging in
To log in, click ’Log In’ at the top right hand corner of the screen. An alternative is to select
‘Incidents’ on the menu. If you are not logged in, you will also be asked to log in, before entering the
incident. Please note you have to be registered to log-in, but you do not need to register to view the
demo of the system shown on the next page.
In order to log in you have to be registered and know your username and password. If you have
forgotten your password you can retrieve it automatically by clicking on ‘Forgot
Username/Password’. Details of how to register are shown later in this document.
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Recording Incidents
Once you have logged in you can record an incident. However if you wish to and familiarise yourself
with the program but not record the data as a patient incident, there is also a demo page available
where you can view the incident recording pages.
Demo site for incident recording –
www.anztadc.net/demo/IncidentTabbed.aspx
WebAIRS is the web based anaesthetic incident recording system. Incident recording starts with the
collection of patient demographics which are entered using the drop down boxes shown above. If no
patient is involved in the incident then click the ‘No patient involved’ box and the drop down boxes
will be hidden from view. If you make an error then clicking ‘Male’ or ‘Female’ will cause the boxes
to re-appear. Enter a description of what happened and how it was managed into the Narrative Box.
When you have finished this part, press the ‘Next’ button. If required, you can return to this tab at
any time using the tabs at the top of this page or the previous button which will be shown on the
next tabbed page.
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Coding Tab (1)
This is the coding tab. As you can see the tab at the top of the current page is shown in grey which is
the background colour of the data input section of the page. The tab(s) of the completed pages are
shown in green and the tabs of the pages that haven’t been visited are shown in amber. Data is
entered on this page using the drop down boxes.
At the top of the page the qualifications of the anaesthetist and the location of the incident are
recorded. Underneath the time of day captures whether the incident occurred during the daytime
shift, the evening or overnight. This is so we can compare the types of incidents recorded during
normal working hours and compare them with those recorded at other times. The hours on duty
captures whether a long working shift was being performed and the hours since an 8 hour break
captures whether there was sufficient rest since the previous working period.
The next line involves incident recording and is slightly more complex that the other pages. Firstly,
when a category is selected then the sub-category box is populated with appropriate subcategories
corresponding to the main category. Then the detection method and severity of this incident is
selected. Secondly if more than one incident occurred during the same episode of care then
additional lines can be added using the yellow ‘Add’ button. This allows multiple categorisations of
the incident or multiple incidents for one patient to be recorded. (see below).
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Coding Tab (2)
This image shows how it is possible to record multiple incidents during one case. In this example
there was an extubation problem followed by an aspiration. Using the add button you can code as
many events for one episode of care as you like and record separately the detection method and the
severity of each event. If a line is incorrectly added then it can be deleted using the grey ‘Del’ button.
If you wish to edit a line, simply delete it using the ‘Del’ button and re-enter the line using the ‘Add’
button.
Underneath the coding categories the overall effects of the episode as well as the final patient
outcome can be recorded using the two drop down boxes.
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Anaesthetic Tab
This page is fairly self explanatory. Firstly the anaesthetic technique components are captured using
the first three dropdown boxes. Then the drugs are entered using freeform text. The airway devices
used, ventilation technique and monitoring used are selected using click boxes. Additional
information can be entered by selecting ‘Other’ and then entering the information into the
corresponding text box. Lastly at the foot of the page additional narrative relating to the anaesthetic
can be recorded.
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Procedure Tab
This page is coded in a similar way to the anaesthetic page. The page does have the following
specific features:
When a specialty is selected then the most common main category is automatically selected.
However this can be overridden and any of the other main categories entered instead. When a main
category is selected for a procedure then the appropriate subcategories are automatically loaded.
The page is completed by entering the full name of the procedure as free text, the procedure length
selected from a drop down box and finally any narrative relating to the procedure may be entered at
the foot of the page.
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Additional Factors Tab
The contributing, alleviating, mitigating factors and additional comments are entered as narrative
using the text boxes on this page.
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Quality Assurance Tab
Finally this page enables some feedback to be given to ANZTADC regarding the preventability of the
incident. Whether the incident would have been reported if not anonymous, the difficulty of
entering the information and whether the user thought an alert should be raised.
How to Register
If you don’t have a username and password, you can register as a user by visiting the WebAIRS home
page and clicking http://www.anztadc.net , then clicking registration in the top right hand side. The
registration page can also be reached by links on the websites of ANZCA, the ASA or the NZSA. Then
the following page is displayed.
To confirm that you are a real user and not an automatic internet program seeking registration a
disguised number is shown that has to be typed in before proceeding. If the number is difficult to
read another number can be requested by clicking the corresponding button.
If you are already registered, then select the first option “I am already
registered ......................” . You will then be directed to log in before selecting more sites with
which to register.
If you wish to register or wish to check your registration select the appropriate
alternate options and you will be guided through the registration process.
After you have registered and logged in then you will be able to select a site with which to register or
to create a new site.
Choose the required option to either register with an existing site or a new site.
Analysis and Results pages
webAIRS Interim Analysis June 2014
CARDIOVASCULAR
403
MISCELLANEOUS/OTHER
156
ASSESSMENT/DOCUMENTATION
155
NEUROLOGICAL
142
INFRASTRUCTURE/SYSTEM
156
MEDICAL DEVICE/EQUIPMENT
OTHER ORGAN
361
41
MEDICATION
400
RESPIRATORY/AIRWAY
644
0
100
200
300
400
500
600
700
Over the past two years, more than 70 hospitals in Australia and New Zealand have registered. The
chart (above) shows the way in which the users of the program have coded the main categories. The
three highest categories are Medication, Medical Device/Equipment and Respiratory/Airway. These
three groups account for approximately 60% of all of the incidents. ANZTADC is currently analysing
and confirming this coding. This will involve drilling down to provide further sub categorisation and
development of strategies to try to prevent similar events from happening in the future. The
confirmed results will be published on the ANZTADC website as well as the publications of the ASA,
ANZCA and the NZSA
Frequently Asked Questions
These are some of the questions that have been asked during the pilot phase.
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Is it a completely anonymous system?
o Yes. However if the user wishes to send an email with some information to their
department quality and safety officer they can do so. The latter feature is completely
optional.
o The user may optionally send an email to themselves with the incident ID number.
This will allow that user to log back in and view the results of the analysis.
o The user may optionally send that ID number to their local quality and safety officer
so that the incident can be reviewed by the anaesthetic department.
Is the confidentiality of the data protected?
o The data is de-identified so individual cases cannot be distinguished from other cases
in the registry. The data is further cleansed and any surrogate identifiers removed
before being analysed.
o The identity of the person who submitted the case is not recorded within the registry.
o The data is protected by provisions of the health legislation in both Australia and New
Zealand.
What is the cost of participating for the individual anaesthetists or the hospital?
There is no cost for members of ANZCA, the ASA or the NZSA. (It is included as a
member service.)
Can data about incidents at the be separated and sent to the participating hospital to
examine, or is all the data pooled together for analysis?
o There are technical difficulties in having an anonymous system but still being able to
extract data for one hospital or one anaesthetist. At present every incident is
allocated a randomly generated incident number. An individual can optionally send
this number by email to themselves and/or their local administrator. The person
accessing the data would first have to log in (first security step) then enter a valid
incident number (second security step). This principle has been extended to generate
an encrypted anonymous name for each hospital and by this means it would be
possible to extract the data for this location. Individual hospitals can opt to use the
system or not as they choose. If an individual anaesthetist opts to send the incident
ID to their local QA officer then it will be able to be retrieved by that person but if not
then it won’t be able to be retrieved in this way. Individual anaesthetists will
therefore be able to opt in or not as per the current anonymous or not option when
they enter each separate incident.
Who analyses the incidents and what is the usual time between the incident and the analysis?
The Alerts and Analysis Sub Committee (Volunteer Anaesthetists) of the Australian and New
Zealand Tripartite Anaesthetic Data Committee (ANZTADC). ANZTADC has started analysing
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the incidents. Results from this data have been used in presentations at the national scientific
meetings of ANZCA, the ASA and NZSA since May 2011. Three articles will be published in the
newsletters and bulletins of the three organisations.
How is the analysis reported back to the hospital or the individual?
o The reports will be sent to fellows of ANZCA via the bulletin, members of the ASA and
NZSA by Newsletter. They will also be permanently shown in the member area of the
ANZTADC website. Analysis on individual cases will not be published in case there is
‘surrogate identification’. Periodically methods for improvement in quality and safety
as well as suggestions for methods to avoid certain incidents will be promulgated.
Is the system approved for CPD credits?
o Yes, the system is approved in the Practice Evaluation Category of the new ANZCA
CPD program at 2 credits per hour. If you enter the time taken to collect the
information the system will add the time taken to enter the information and then
calculate the credits for you. You can then either print out a certificate or have
confirmation emailed to you. No permanent record of your activity is stored on the
system. An alternative would be to record the activity in your diary.
Does the system require ethics approval.
o The National Health and Medical Research Council guidelines advise that Ethics
approval is not always required for quality assurance activities. However they do
recommend following the same principles that ethics committees consider when
dealing with patient data. ANZTADC can supply documentation to assist with ethics
approval if your ethics committee requires a review.
o Privacy legislation – ANZTADC complies with the Australian Privacy Principles that
were released in March 2014 and can supply documentation to support this
statement if required by your organisation.
Further information can be obtained from
ANZTADC Data Officer, [email protected]