Letters to the Editor:
Advantages of Automated Anesthesia Record Prevail
To the Editor:
I read with interest the letter by Dr. Metz in the Winter 2001-2002 APSF Newsletter1 regarding the possible medicolegal liabilities of automated records. Unfortunately, he raises yet again the specter of artifactual values being recorded and subsequently misinterpreted by plaintiff's attorneys.
This issue is as old as the technology, and it was well addressed in numerous reviews in the late 1980s.2-4 The argument of recorded artifacts leading to litigation is more than balanced by the improved "professional appearance" of the record, the capture of QA data for monitoring and performance improvement, and the removal of the subjectivity and potential dishonesty in recording the intrinsic variability of data. Perhaps Dr. Metz is aware of a case where the automated record has indicted the anesthesiologist? Even after the dire predictions of the past (and present), there seems to be no confirmation in reality.
I agree with the APSF that the promise of increased safety through analysis of event records free of subjective bias outweighs any unproven concern over potential litigation. As always, the best defense against liability claims is good medicine combined with good communication.
James M. Berry, MD
Jackson, MS
APSF Deserves Support
To the Editor:
As a member of the American Society of Anesthesiologists, I support the funding that the Society provides to the APSF. The APSF Newsletter provides me with valuable, stimulating, interesting, and sometimes controversial information. In reading the latest issue of the Newsletter, I couldn't help but notice that APSF financial support comes only from physicians, physicians' organizations, a non-CRNA anesthesia society, a few pharmaceutical and medical equipment companies, and one medical malpractice defense company. With the righteous indignation about medical errors disseminated by the television and print media, I find it amazing and frustrating that our federal and state government agencies (Medicare, Medicaid), consumer groups like AARP and The Leapfrog Group, health care and insurance organizations, big business and malpractice plaintiff attorneys do not support the APSF. Shouldn't financial support for the ongoing work to improve patient safety also come from those who gain most--the health care consumer? With the continued reductions in our reimbursement, physicians cannot be expected to continue to bear most of the financial burden in working toward patient safety.
Anthony R. Palmer, MD
Arlington, Texas
Modifications Recommended for Locked Carts
To the Editor:
I would like to respond to Daniel Yousif's comments made in the winter 2001-2002 APSF Newsletter regarding the potential hazards of locked anesthesia carts.
Our institution initiated a (perhaps the same) locking anesthesia cart system almost 2 years ago. This system was implemented in our department for the same reasons, JCAHO and pharmacy narcotic control/wastage issues. As with any new technology that may affect clinical practice, I heard many of the same concerns from anesthesiologists and CRNAs: What will be the impact of this system on the hospital's fiscal plan, and, more importantly, how will it address issues of patient safety, such as allowing retrieval of needed supplies and drugs from a malfunctioning cart?
While there is a learning curve associated with implementing these systems, I believe the negative impact can be reduced. Our department made several modifications to our locking cart system including disengaging drawers not containing drugs and setting up back-up boxes in case of an emergency.
It is not my intention to defend the locked cart system, merely to offer alternative ways to use it to our best advantage.
Ron Snelling, RRT, CerATT
Denver, CO