In our region, patients frequently receive care across multiple facilities—pre-op testing in one place, surgery at another, and follow-up with different providers. Add in the speed of perioperative care, and the most important questions become very specific:
- How quickly did the team respond to abnormal vitals or breathing changes?
- What doses were administered and when (and were they documented consistently)?
- Who monitored the patient at key moments—especially during transitions between care areas?
- Were handoffs clear between anesthesia staff, nursing teams, and post-anesthesia recovery?
These cases are often less about a single “bad moment” and more about whether the care team met the expected standard as the situation unfolded.


