Navigating complexity: futureproofing anaesthesia for patient safety

Medical error is a well-recognised contributor to patient harm worldwide and is increasingly acknowledged as a major cause of preventable morbidity and mortality.In the United States, it is estimated to be among the leading causes of death. 1 Hogan et al. reported that 3.6% of in-hospital deaths were avoidable and attributed to medical error. 2 Defined as "the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim", 3 medical error can result in a spectrum of outcomes, ranging from near misses to patient injury or death.Anaesthesiologists practise in highly complex, time-critical environments where rapid and high-stakes decisions are frequently required.We care for patients across the entire lifespan, from neonates to the elderly, and in diverse clinical settings, including the operating theatre, labour ward, emergency department, and intensive care unit.Each anaesthetic encounter is unique, even for the same surgical procedure, because of variations in patient characteristics, comorbidities, and surgical context.For this reason, comparing the practice of anaesthesia to aviation is misleading.The unpredictability and urgency of decision-making in anaesthesia extend well beyond the protocol-driven systems typical of aviation.