Circulation 122,210 • Volume 35, No. 1 • February 2020   Issue PDF

2020 President’s Report: What APSF is Doing to Promote Perioperative Patient Safety and How Each of Us Can Make a Positive Impact

Mark A. Warner, MD
Dr. Mark Warner, APSF President

Dr. Mark Warner, APSF President

There are many opportunities available to us as a specialty as well as individually to improve the safety of our patients as they go through their perioperative episodes of care. As a specialty, and for APSF, specifically, we must prioritize high-value issues that need to be addressed. As individuals, we must focus acutely on the safety of each and every one of our patients…every day.

APSF’s Patient Safety Priorities and Partnerships

There are specific issues that we all know need to be addressed. Table 1 provides a list of the top perioperative patient safety issues that the APSF believes need targeted attention, discussion, and support at this time, no matter where you live and work. We use this set of global priority issues to help us determine the topics of our Stoelting Conferences, solicit articles for our APSF Newsletter, drive social media content, and allocate resources for research and education projects.

Table 1: APSF’s 2020 Top Ten Perioperative Patient Safety Priorities

  1. Preventing, detecting, and mitigating clinical deterioration in the perioperative period
    1. Early warning systems in all perioperative patients
    2. Monitoring for patient deterioration
      1. Postoperative continuous monitoring on the hospital floor
      2. Opioid-induced ventilatory impairment and monitoring
      3. Early sepsis
    3. Early recognition and response to decompensating patient
  2. Safety in out-of-operating room locations such as endoscopy and interventional radiology suites
  3. Culture of safety: the importance of teamwork and promoting collegial personnel interactions to support patient safety
  4. Medication safety
    1. Drug effects
    2. Labeling issues
    3. Shortages
    4. Technology issues (e.g., barcoding, RFID)
    5. Processes for avoiding and detecting errors
  5. Perioperative delirium, cognitive dysfunction, and brain health
  6. Hospital-acquired infections and environmental microbial contamination and transmission
  7. Patient-related communication issues, handoffs, and transitions of care
  8. Airway management difficulties, skills, and equipment
  9. Anesthesia professionals and burnout
  10. Distractions in procedural areas

Beyond these global topics on perioperative patient safety, there are local issues that impact patient safety. Examples include limitations on personnel, equipment, and medications. While present to some degree everywhere, these limitations are most prevalent in lower resource countries. These issues often must be addressed through global as well as regional or local partnerships. The APSF is partnering with the World Federation of Societies of Anaesthesiologists (WFSA) and other global and regional organizations to assist with improving education opportunities for anesthesia professionals. Specific to the WFSA, we are supporting efforts to ensure that the value of subspecialty fellowships offered by the WFSA around the world is consistently high. We also are collaborating with the Patient Safety Movement Foundation to develop an anesthesia-specific patient safety curriculum for training programs and for individual practitioners, with adaptations that will make it applicable for use in both high- and limited-resource countries. Thanks to the efforts of our newsletter and social media leaders, Steven B. Greenberg, MD, and Marjorie P. Stiegler, MD, respectively, APSF’s patient safety recommendations and articles now reach more than 600,000 anesthesia professionals worldwide, in every country and on every continent of the globe, with information on important topics in perioperative patient safety.

What Each of Us Can Do to Have a Positive Impact on Patient Safety

Beyond the efforts of APSF and many of our specialty’s professional organizations to improve perioperative patient safety, there are actions we all can take to improve patient safety­—individually and every day. For example, we can simply follow the Golden Rule, “Treat others as you would like to be treated.” This rule is not tied to any culture and appears in some modification in all of the world’s major religions and regions.

Basically, we need to take a few deep breaths before patients come under our care and consider how we would wish to be treated if we were in their places. Over the years I’ve had the good fortune to be able to study several major perioperative morbidities in detail (e.g., pulmonary aspiration, ulnar neuropathy, and pneumonias). I’ve also had the misfortune to have cared for patients who have suffered from these and other significant perioperative complications. Like many of you, I’ve seen patients receive medications in error, sometimes with significant detrimental events associated with them. I can tell you from personal experience that an unanticipated perioperative infection is not the outcome you wish to have. While many of these morbidities have complex, confounding etiologies that involve patient characteristics and patient care that spans the perioperative continuum, we can and must do better at reducing our personal errors or omissions that can negatively impact the safety of our patients. It is the right thing to do for our patients. It is what we would want from our colleagues when we are the patients.

Before providing care for individual patients, we might ask ourselves:

  • Have we used checklists to ensure that we have everything we need at hand when we proceed with anesthetic care?
  • Have we actively avoided contamination of our equipment and medications to reduce the risk of microorganism transmission perioperatively?
  • Have we made the effort to know our patients and their risk factors for potential intraoperative or postoperative complications?
  • Have we allowed production pressures or distractions (e.g., cell phones) to interfere with our focused efforts to provide the best care we can?
  • Have we provided the appropriate handoff communication before leaving the patients in another anesthesia professional’s care?
  • Are we “treating our patients as we would like to personally be treated”?

For all of our patients, we might ask:

  • Have we participated in our local institutions to develop the clinical pathways, practices, and policies that increase their safety throughout the perioperative period?
  • Have we worked within our institutions and with our colleagues to improve team interactions and implement the cultural changes that allow all members of the perioperative team to point out actions that might cause patient harm?
  • Have we taken leadership roles, locally or beyond, that allow us to make a positive impact on the perioperative safety of the populations we serve?

Perioperative patient safety is not something that someone else can resolve. The APSF and other organizations can provide the resources to assist clinician investigators and others to develop new knowledge that can improve patient safety. These organizations can help develop recommendations that can be used to guide care and potentially improve patient safety. Our industry partners can develop the new equipment and medications that contribute to safer care. However, each of us has a personal responsibility to contribute to improved perioperative patient safety. Deliberate consideration of the Golden Rule before providing care to each patient seems essential.


Dr. Mark Warner is currently president of the APSF and the Annenberg Professor of Anesthesiology, Mayo Clinic, Rochester, MN.

Dr. Warner has no disclosures with regards to the content of the article.

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