const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE"; // 13.3" x 7.5"
pres.title = "Closed Claims Analysis and Patient Safety in Anesthesia Practice";
pres.author = "Seminar Presentation";

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const WHITE  = "FFFFFF";
const LTGRAY = "D6E4EE";
const MIDBLUE= "1A4C7C";
const SILVER = "A8BDD0";

// ── SHARED HELPERS ──────────────────────────────────────────────
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// ══════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE SLIDE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
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  s.addText("AND PATIENT SAFETY IN", {
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  s.addText("ANESTHESIA PRACTICE", {
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  s.addText("Source: Barash Clinical Anesthesia 9e · Miller's Anesthesia 10e · Morgan & Mikhail 7e", {
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    fontSize: 11, color: SILVER, fontFace: "Calibri", italic: true
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}

// ══════════════════════════════════════════════════════════════════
// SLIDE 2 – OVERVIEW / AGENDA
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, NAVY);
  accentBar(s, GOLD);
  slideHeading(s, "Seminar Overview");

  const topics = [
    "01  What is the ASA Closed Claims Project?",
    "02  Historical Context & the Patient Safety Movement",
    "03  Methodology of Claims Analysis",
    "04  Distribution & Types of Claims",
    "05  Leading Injuries: Death, Brain Damage, Nerve Injury",
    "06  Airway-Related Claims",
    "07  Cardiovascular & Respiratory Events",
    "08  Regional & Obstetric Anesthesia Claims",
    "09  Non-OR Location & Office-Based Anesthesia",
    "10  Human Error, Equipment & Situational Awareness",
    "11  Communication Failures & Medication Errors",
    "12  Preventability & Standard of Care",
    "13  Lessons Learned & Safety Improvements",
    "14  Future Directions in Patient Safety",
    "15  Key Takeaways & Conclusions",
  ];

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}

// ══════════════════════════════════════════════════════════════════
// SLIDE 3 – WHAT IS THE ASA CLOSED CLAIMS PROJECT?
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, NAVY);
  accentBar(s, TEAL);
  slideHeading(s, "The ASA Closed Claims Project");

  // Info box
  s.addShape(pres.ShapeType.rect, {
    x: 0.32, y: 1.05, w: 12.6, h: 1.1,
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    '"The goal is to identify common events leading to claims in anesthesia, patterns of injury, and strategies for injury prevention."',
    { x: 0.42, y: 1.1, w: 12.3, h: 1.0, fontSize: 16, italic: true, color: GOLD, fontFace: "Calibri", valign: "middle" }
  );
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    x: 0.42, y: 2.08, w: 12, h: 0.3, fontSize: 12, color: SILVER, italic: true
  });

  bodyText(s, [
    bulletItem("Founded 1984 by the ASA and University of Washington, Seattle", 0, 17, true),
    subBullet("Funded by ASA since 1985; transferred to Anesthesia Quality Institute (AQI) in 2019"),
    bulletItem("A nationwide retrospective collection of closed malpractice claims against anesthesiologists", 0, 17),
    subBullet("Excludes dental damage; covers physician anesthesiologists only"),
    bulletItem("Database growth: ~4,000 claims by 1999 → ~9,000 by 2011 → >11,300 by 2014", 0, 17),
    bulletItem("Provides a 'snapshot' of liability — NOT an incidence study", 0, 17, true),
    subBullet("Only events leading to a malpractice filing are captured"),
    bulletItem("Trained physicians review claims grouped by: damaging event, complication type, and outcome", 0, 17),
    bulletItem("Has generated >60 peer-reviewed publications on airway, OB, pain, nerve injury, awareness, etc.", 0, 17),
  ], { y: 2.45, h: 4.8 });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 4 – HISTORICAL CONTEXT & PATIENT SAFETY MOVEMENT
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, NAVY);
  accentBar(s, GOLD);
  slideHeading(s, "Historical Context & the Patient Safety Movement");

  // Timeline boxes
  const events = [
    { yr: "1846", txt: "First death attributed to ether anesthesia" },
    { yr: "1948–52", txt: "Beecher & Todd: anesthesia killed more than poliomyelitis" },
    { yr: "1982", txt: 'ABC TV "The Deep Sleep — 6,000 Will Die or Suffer Brain Damage"' },
    { yr: "1984", txt: "ASA Closed Claims Project founded (E.C. Pierce Jr.)" },
    { yr: "1985", txt: 'APSF founded: "No patient shall be harmed by anesthesia"' },
    { yr: "1986", txt: "ASA Basic Standards for Intraoperative Monitoring approved" },
    { yr: "1996", txt: "AMA founds National Patient Safety Foundation" },
    { yr: "1999", txt: 'IOM Report "To Err is Human" — landmark patient safety document' },
    { yr: "2019", txt: "Closed Claims database transferred to AQI" },
  ];

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}

// ══════════════════════════════════════════════════════════════════
// SLIDE 5 – METHODOLOGY
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, NAVY);
  accentBar(s, TEAL);
  slideHeading(s, "Methodology of Closed Claims Analysis");

  const boxes = [
    { title: "DATA SOURCE", body: "Closed malpractice insurance claims from U.S. insurers representing physician anesthesiologists" },
    { title: "REVIEWERS", body: "Trained anesthesiologist-physicians conduct structured review of each claim" },
    { title: "GROUPING", body: "Claims classified by: damaging event type, complication type, patient outcome, and payment status" },
    { title: "LIMITATIONS", body: "Cannot determine true complication incidence; claims may occur without negligence and negligence may occur without claims" },
    { title: "COMPARISON", body: "UK: NHS Litigation Authority dataset reviewed in parallel; anesthesia = 2.5% of total NHS claims (2009)" },
    { title: "STRENGTHS", body: "Large real-world dataset; identifies rare but serious events; guides safety standards and guidelines" },
  ];

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}

// ══════════════════════════════════════════════════════════════════
// SLIDE 6 – DISTRIBUTION & TYPES OF CLAIMS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, NAVY);
  accentBar(s, GOLD);
  slideHeading(s, "Distribution & Types of Anesthesia Claims (2005–2014)");

  // Claim type visual bars (approximate % from text)
  const cats = [
    { label: "Surgical Anesthesia", pct: 65, color: TEAL },
    { label: "Chronic Pain Management", pct: 18, color: MIDBLUE },
    { label: "Obstetric Anesthesia", pct: 11, color: GOLD },
    { label: "Acute Pain Management", pct: 6, color: SILVER },
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    bulletItem("Total claims (2005–2014): n = 11,306", 0, 14),
    bulletItem("Surgical anesthesia remains the leading source of claims", 0, 14),
    bulletItem("OB, acute pain & chronic pain together: ~33% of all claims", 0, 14),
    bulletItem("Chronic pain claims have increased significantly over time", 0, 14),
    bulletItem("Claims from non-OR locations are growing rapidly", 0, 14),
  ], { x: 9.0, y: 1.6, w: 3.8, h: 5.3, valign: "top", margin: 4 });

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    x: 0.32, y: 6.95, w: 8.5, h: 0.35, fontSize: 11, color: SILVER, italic: true
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 7 – LEADING INJURIES
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, NAVY);
  accentBar(s, TEAL);
  slideHeading(s, "Leading Injuries in Anesthesia Malpractice Claims (2005–2014)");

  // Injury donut visual (horizontal bars)
  const injuries = [
    { label: "Death",                  pct: 30, color: "#C0392B" },
    { label: "Nerve Damage",           pct: 21, color: GOLD },
    { label: "Permanent Brain Damage", pct: 9,  color: "#E67E22" },
    { label: "Airway Injury",          pct: 7,  color: TEAL },
    { label: "Burns (OR fires)",       pct: 5,  color: SILVER },
    { label: "Emotional Distress",     pct: 5,  color: MIDBLUE },
    { label: "Other",                  pct: 23, color: "#5D6D7E" },
  ];

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      x: bX, y: y, w: bw, h: bH,
      fill: { color: inj.color }, line: { type: "none" }
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      x: bX + 0.1, y: y, w: Math.max(bw - 0.2, 2.5), h: bH,
      fontSize: 14, bold: true, color: NAVY, valign: "middle"
    });
  });

  // Right note box
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    x: 8.5, y: 1.05, w: 4.5, h: 6.1,
    fill: { color: MIDBLUE }, line: { color: GOLD, pt: 1.5 }
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  s.addText("TREND HIGHLIGHTS", { x: 8.6, y: 1.12, w: 4.3, h: 0.4, fontSize: 14, bold: true, color: GOLD, align: "center" });
  s.addText([
    bulletItem("1970s: 64% of claims involved permanent injury or death", 0, 13),
    bulletItem("By 1990s: reduced to 41%", 0, 13),
    bulletItem("1990–2007: death + brain damage still 35% of claims", 0, 13),
    bulletItem("Nerve injury claims have increased over time", 0, 13),
    bulletItem("Chronic pain and acute pain claims are growing", 0, 13),
    bulletItem("Respiratory events: 56% of brain injury/death in 1975 → ~28% by 2000 (due to pulse ox & capnography)", 0, 13),
  ], { x: 8.6, y: 1.6, w: 4.3, h: 5.3, valign: "top", margin: 4 });

  s.addText("Source: Barash Clinical Anesthesia 9e, Fig 4-2  |  n = 11,306", {
    x: 0.32, y: 6.95, w: 8.5, h: 0.35, fontSize: 11, color: SILVER, italic: true
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 8 – AIRWAY-RELATED CLAIMS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, NAVY);
  accentBar(s, GOLD);
  slideHeading(s, "Airway-Related Claims: A Major Safety Focus");

  bodyText(s, [
    bulletItem("Airway management problems: primary cause of death & brain damage in early dataset", 0, 17, true),
    subBullet("Inadequate ventilation, esophageal intubation, premature extubation, aspiration"),
    bulletItem("Closed Claims data drove development of the ASA Difficult Airway Algorithm", 0, 17, true),
    subBullet("Also promoted standards for pulse oximetry and end-tidal CO₂ monitoring"),
    bulletItem("UK NHS data: airway-related claims → highest awards & worst outcomes", 0, 17),
    subBullet("Airway manipulation and central venous catheterisation most associated with patient death"),
    bulletItem("2019 review: Clinical judgment failures common in difficult intubation claims", 0, 17),
    subBullet("Delays persist in securing surgical airway in 'Can't Intubate, Can't Ventilate' scenarios"),
    bulletItem("Failure to correctly interpret capnography → missed esophageal intubations", 0, 17),
    bulletItem("Postintubation mediastinitis after repeated airway manipulations: rare but life-threatening", 0, 17),
    subBullet("Early intervention offers best chance of mitigating injury"),
  ], { y: 1.15, h: 5.9 });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 9 – CARDIOVASCULAR & RESPIRATORY EVENTS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, NAVY);
  accentBar(s, TEAL);
  slideHeading(s, "Cardiovascular & Respiratory Damaging Events");

  // Two-column layout
  s.addShape(pres.ShapeType.rect, {
    x: 0.32, y: 1.08, w: 6.0, h: 5.9,
    fill: { color: MIDBLUE }, line: { color: TEAL, pt: 1 }
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    x: 0.32, y: 1.08, w: 6.0, h: 0.45,
    fill: { color: TEAL }, line: { type: "none" }
  });
  s.addText("RESPIRATORY EVENTS", { x: 0.42, y: 1.12, w: 5.8, h: 0.36, fontSize: 14, bold: true, color: NAVY });
  s.addText([
    bulletItem("Dominant cause early 1970s–mid 1980s (>50% of brain injury/death)", 0, 14),
    bulletItem("Declined with introduction of pulse oximetry and capnometry", 0, 14),
    subBullet("Standard monitoring introduced from Closed Claims findings"),
    bulletItem("Substandard care found in 64% of respiratory-related injury claims", 0, 14),
    bulletItem("Common mechanisms:", 0, 14, true),
    subBullet("Esophageal intubation"),
    subBullet("Premature extubation"),
    subBullet("Inadequate ventilation"),
    subBullet("Unrecognised breathing circuit disconnection"),
  ], { x: 0.42, y: 1.58, w: 5.8, h: 5.2, valign: "top", margin: 3 });

  s.addShape(pres.ShapeType.rect, {
    x: 6.8, y: 1.08, w: 6.2, h: 5.9,
    fill: { color: MIDBLUE }, line: { color: GOLD, pt: 1 }
  });
  s.addShape(pres.ShapeType.rect, {
    x: 6.8, y: 1.08, w: 6.2, h: 0.45,
    fill: { color: GOLD }, line: { type: "none" }
  });
  s.addText("CARDIOVASCULAR EVENTS", { x: 6.9, y: 1.12, w: 6.0, h: 0.36, fontSize: 14, bold: true, color: NAVY });
  s.addText([
    bulletItem("Responsible for 27% of brain injury/death claims in early study period", 0, 14),
    bulletItem("By late 1980s: equal contributor to respiratory events", 0, 14),
    bulletItem("Usually multifactorial in nature", 0, 14, true),
    bulletItem("Common causes:", 0, 14, true),
    subBullet("Pulmonary embolism"),
    subBullet("Inadequate fluid therapy"),
    subBullet("Stroke"),
    subBullet("Haemorrhage"),
    subBullet("Myocardial infarction"),
    bulletItem("Substandard care found in only 28% of cardiovascular claims (vs 64% for respiratory)", 0, 14),
    subBullet("Suggests many CV events occur despite appropriate management"),
  ], { x: 6.9, y: 1.58, w: 6.0, h: 5.2, valign: "top", margin: 3 });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 10 – REGIONAL & OBSTETRIC ANESTHESIA CLAIMS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, NAVY);
  accentBar(s, GOLD);
  slideHeading(s, "Regional & Obstetric Anesthesia Claims");

  bodyText(s, [
    bulletItem("UK NHS analysis (2009): Regional + OB anesthesia = 73% of all anesthesia claims", 0, 17, true),
    subBullet("Regional: 44%  |  Obstetric: 29%"),
    bulletItem("OB anesthesia claims — common issues:", 0, 17, true),
    subBullet("Failed or inadequate neuraxial block"),
    subBullet("Post-dural puncture headache"),
    subBullet("High spinal / total spinal"),
    subBullet("Maternal cardiac arrest"),
    subBullet("Newborn brain injury related to maternal hypoxia"),
    bulletItem("Regional anesthesia claims — common issues:", 0, 17, true),
    subBullet("Nerve injury following peripheral nerve blocks"),
    subBullet("Intravascular injection with local anaesthetic toxicity"),
    subBullet("Epidural haematoma and abscess"),
    bulletItem("Vascular cannulation (central venous access) — patient death in 47% of claims", 0, 17, true),
    subBullet("High-profile target area: ultrasound guidance has reduced but not eliminated claims"),
    bulletItem("Central line claims contributed significantly to non-respiratory/CV mortality data", 0, 17),
  ], { y: 1.15, h: 5.9 });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 11 – NON-OR & OFFICE-BASED ANESTHESIA
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, NAVY);
  accentBar(s, TEAL);
  slideHeading(s, "Non-OR Locations & Office-Based Anesthesia");

  const cards = [
    {
      title: "GROWTH OF NON-OR ANESTHESIA",
      body: "Increasing claims from procedures outside the OR: endoscopy, radiology, cardiac cath labs, psychiatry (ECT), and office-based procedures"
    },
    {
      title: "UNIQUE HAZARDS",
      body: "Limited monitoring equipment, no immediate backup, unfamiliar teams, restricted access to patient, inadequate resuscitation facilities"
    },
    {
      title: "OFFICE-BASED SAFETY CONCERNS",
      body: "Growth provokes safety fears (APSF, 2000). Closed claims highlight: inadequate pre-op evaluation, over-sedation, poor monitoring compliance"
    },
    {
      title: "KEY CLAIMS PATTERNS",
      body: "Higher proportion of MAC (Monitored Anesthesia Care) cases; OR fires during MAC with electrocautery + supplemental oxygen are a recurring theme"
    },
    {
      title: "OPHTHALMIC ANESTHESIA",
      body: "OMIC closed claims (2021): 13 deaths during eye surgery under GA. Perioperative MI & aspiration were leading causes — heightened vigilance required"
    },
    {
      title: "MITIGATION STRATEGIES",
      body: "Pre-procedure site assessment, standardised monitoring, emergency protocols, dedicated anaesthesia provider, adequate post-procedure recovery area"
    },
  ];

  const bw = 4.0, bh = 1.6, gap = 0.22;
  cards.forEach((c, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.32 + col * (bw + 0.22);
    const y = 1.18 + row * (bh + gap);

    s.addShape(pres.ShapeType.rect, { x, y, w: bw, h: bh, fill: { color: MIDBLUE }, line: { color: TEAL, pt: 1 } });
    s.addShape(pres.ShapeType.rect, { x, y, w: bw, h: 0.38, fill: { color: TEAL }, line: { type: "none" } });
    s.addText(c.title, { x: x + 0.08, y: y + 0.04, w: bw - 0.16, h: 0.32, fontSize: 12, bold: true, color: NAVY, valign: "middle" });
    s.addText(c.body, { x: x + 0.1, y: y + 0.42, w: bw - 0.2, h: bh - 0.5, fontSize: 13, color: WHITE, valign: "top", margin: 3 });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 12 – HUMAN ERROR & EQUIPMENT FAILURE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, NAVY);
  accentBar(s, GOLD);
  slideHeading(s, "Human Error, Equipment Failure & Situational Awareness");

  s.addText("Studies show most preventable anesthetic accidents involve HUMAN ERROR, not equipment failure", {
    x: 0.32, y: 1.08, w: 12.6, h: 0.5,
    fontSize: 17, bold: true, color: GOLD, italic: true, valign: "middle"
  });

  // Two boxes
  s.addShape(pres.ShapeType.rect, { x: 0.32, y: 1.68, w: 5.9, h: 3.5, fill: { color: MIDBLUE }, line: { color: GOLD, pt: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 0.32, y: 1.68, w: 5.9, h: 0.42, fill: { color: GOLD }, line: { type: "none" } });
  s.addText("HUMAN ERRORS (Table 54-1)", { x: 0.42, y: 1.72, w: 5.7, h: 0.34, fontSize: 13, bold: true, color: NAVY });
  s.addText([
    bulletItem("Unrecognised breathing circuit disconnection", 0, 14),
    bulletItem("Mistaken drug administration", 0, 14),
    bulletItem("Airway mismanagement", 0, 14),
    bulletItem("Anaesthesia machine misuse", 0, 14),
    bulletItem("Fluid mismanagement", 0, 14),
    bulletItem("Intravenous line disconnection", 0, 14),
  ], { x: 0.42, y: 2.16, w: 5.7, h: 2.9, valign: "top", margin: 3 });

  s.addShape(pres.ShapeType.rect, { x: 6.7, y: 1.68, w: 6.0, h: 3.5, fill: { color: MIDBLUE }, line: { color: TEAL, pt: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 6.7, y: 1.68, w: 6.0, h: 0.42, fill: { color: TEAL }, line: { type: "none" } });
  s.addText("EQUIPMENT MALFUNCTIONS (Table 54-2)", { x: 6.8, y: 1.72, w: 5.8, h: 0.34, fontSize: 13, bold: true, color: NAVY });
  s.addText([
    bulletItem("Breathing circuit failure", 0, 14),
    bulletItem("Monitoring device malfunction", 0, 14),
    bulletItem("Ventilator failure", 0, 14),
    bulletItem("Anaesthesia machine malfunction", 0, 14),
    bulletItem("Laryngoscope failure", 0, 14),
  ], { x: 6.8, y: 2.16, w: 5.8, h: 2.9, valign: "top", margin: 3 });

  // Situational awareness box
  s.addShape(pres.ShapeType.rect, { x: 0.32, y: 5.28, w: 12.6, h: 1.7, fill: { color: "1A1A2E" }, line: { color: GOLD, pt: 1.5 } });
  s.addText("SITUATIONAL AWARENESS — 3 Elements (Morgan & Mikhail 7e)", {
    x: 0.42, y: 5.32, w: 12.3, h: 0.4, fontSize: 13, bold: true, color: GOLD
  });
  s.addText([
    { text: "① Perception: ", options: { bold: true, color: GOLD, fontSize: 14 } },
    { text: "Detection of relevant clinical information   ", options: { color: WHITE, fontSize: 14 } },
    { text: "② Comprehension: ", options: { bold: true, color: TEAL, fontSize: 14 } },
    { text: "Using perceived info to arrive at diagnosis   ", options: { color: WHITE, fontSize: 14 } },
    { text: "③ Projection: ", options: { bold: true, color: SILVER, fontSize: 14 } },
    { text: "Predicting patient course & mitigating harm", options: { color: WHITE, fontSize: 14 } },
  ], { x: 0.42, y: 5.74, w: 12.3, h: 1.1, valign: "middle" });

  s.addText("Situational awareness errors contributed to ¾ of claims for death and brain injury (2002–2013)", {
    x: 0.42, y: 6.82, w: 12.3, h: 0.35, fontSize: 12, color: SILVER, italic: true
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 13 – COMMUNICATION FAILURES & MEDICATION ERRORS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, NAVY);
  accentBar(s, TEAL);
  slideHeading(s, "Communication Failures & Medication Errors");

  bodyText(s, [
    bulletItem("Communication failures are a leading contributor to preventable anesthetic adverse events", 0, 17, true),
    subBullet("Closed Claims publications specifically highlight communication during adverse events (post-2010)"),
    bulletItem("Medication management errors are among the top causes of anesthesia-related malpractice claims", 0, 17, true),
    subBullet("Wrong drug, wrong dose, wrong route, wrong patient"),
    subBullet("Look-alike / sound-alike drug ampoules in the anaesthetic workspace"),
    bulletItem("Situational awareness errors — linked to communication breakdown:", 0, 17),
    subBullet("Failure to act on monitor alarms"),
    subBullet("Incomplete handover during team transitions"),
    subBullet("Poor communication between surgeon and anaesthesiologist"),
    bulletItem("Future safety improvements MUST address:", 0, 17, true),
    subBullet("Structured communication frameworks (SBAR, read-back protocols)"),
    subBullet("Standardised drug labelling, colour-coded syringes"),
    subBullet("Pre-procedure briefings and surgical safety checklists (WHO checklist)"),
    bulletItem("Awareness under anesthesia claims: often linked to failure to communicate depth-of-anaesthesia findings", 0, 17),
  ], { y: 1.15, h: 5.9 });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 14 – PREVENTABILITY & STANDARD OF CARE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, NAVY);
  accentBar(s, GOLD);
  slideHeading(s, "Preventability & Standard of Care");

  // Stat highlight
  s.addShape(pres.ShapeType.rect, {
    x: 0.32, y: 1.08, w: 12.6, h: 1.0,
    fill: { color: MIDBLUE }, line: { color: GOLD, pt: 1.5 }
  });
  s.addText("< 1 in 25 patient injuries results in a malpractice suit  |  Anesthetic mishaps: preventable vs. unpreventable", {
    x: 0.42, y: 1.14, w: 12.3, h: 0.88, fontSize: 15, bold: true, color: GOLD, valign: "middle", italic: true
  });

  bodyText(s, [
    bulletItem("Preventable adverse events: primarily due to human error (not equipment failure)", 0, 17, true),
    subBullet("Some rate of human error is inevitable — system-level solutions required"),
    bulletItem("Standard of care is established by expert testimony in court", 0, 17),
    subBullet("Expert credibility based on: training, practice scope, publications, affiliations"),
    bulletItem("OUTCOME BIAS: Severity of injury influences expert assessment of standard of care", 0, 17, true),
    subBullet("Study of 112 anesthesiologists: ratings for 'appropriate care' decreased when outcome changed temporary → permanent"),
    subBullet("This bias may contribute to frequency and size of malpractice payments"),
    bulletItem("ASA practice guidelines ≠ absolute standards — may be modified per clinical context", 0, 17),
    bulletItem("Respiratory claims: substandard care in 64%  vs  CV claims: 28%", 0, 17, true),
    subBullet("Most cardiovascular adverse outcomes represent unavoidable patient pathology"),
  ], { y: 2.18, h: 4.7 });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 15 – LESSONS LEARNED & SAFETY IMPROVEMENTS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, NAVY);
  accentBar(s, TEAL);
  slideHeading(s, "Lessons Learned, Safety Improvements & Future Directions");

  // 3-column layout
  const cols = [
    {
      title: "MONITORING STANDARDS",
      color: TEAL,
      items: [
        "Mandatory pulse oximetry & end-tidal CO₂",
        "Capnography in all intubated patients",
        "Closed Claims data directly shaped ASA monitoring standards",
        "Neuromuscular blockade monitoring",
        "BIS/depth-of-anaesthesia monitoring for awareness prevention",
      ]
    },
    {
      title: "GUIDELINES & PROTOCOLS",
      color: GOLD,
      items: [
        "ASA Difficult Airway Algorithm",
        "WHO Surgical Safety Checklist",
        "Pre-anaesthesia machine check protocols",
        "Structured handover tools (SBAR)",
        "Regional block safety protocols (US guidance, test dose)",
        "Crisis resource management training",
      ]
    },
    {
      title: "FUTURE DIRECTIONS",
      color: SILVER,
      items: [
        "Electronic health record integration for claim tracking",
        "Simulation-based training for rare but high-stakes events",
        "Artificial intelligence for early adverse event detection",
        "Non-OR and office-based safety accreditation",
        "Mandatory incident reporting systems",
        "Continued APSF research funding for emerging risks",
      ]
    },
  ];

  const cw = 4.0, ch = 5.85;
  cols.forEach((col, i) => {
    const x = 0.32 + i * (cw + 0.22);
    const y = 1.1;
    s.addShape(pres.ShapeType.rect, { x, y, w: cw, h: ch, fill: { color: MIDBLUE }, line: { color: col.color, pt: 1.5 } });
    s.addShape(pres.ShapeType.rect, { x, y, w: cw, h: 0.45, fill: { color: col.color }, line: { type: "none" } });
    s.addText(col.title, { x: x + 0.08, y: y + 0.05, w: cw - 0.16, h: 0.36, fontSize: 13, bold: true, color: NAVY, valign: "middle" });
    const items = col.items.map((t, j) => ({
      text: t,
      options: { bullet: true, fontSize: 13.5, color: WHITE, breakLine: j < col.items.length - 1, lineSpacingMultiple: 1.3 }
    }));
    s.addText(items, { x: x + 0.12, y: y + 0.52, w: cw - 0.24, h: ch - 0.6, valign: "top", margin: 3 });
  });

  // bottom quote
  s.addShape(pres.ShapeType.rect, {
    x: 0.32, y: 7.05, w: 12.6, h: 0.38,
    fill: { color: "1A1A2E" }, line: { type: "none" }
  });
  s.addText('"No patient shall be harmed by anesthesia." — APSF Mission Statement, 1985', {
    x: 0.42, y: 7.07, w: 12.3, h: 0.33,
    fontSize: 13, color: GOLD, italic: true, align: "center", valign: "middle"
  });
}

// ══════════════════════════════════════════════════════════════════
// WRITE FILE
// ══════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/closed-claims-ppt/Closed_Claims_Analysis_Anesthesia.pptx" })
  .then(() => console.log("✅ Presentation saved successfully!"))
  .catch(err => console.error("❌ Error:", err));