Recent data continues to confirm the epidemic of preventable harm in American health care. In 2022 the U.S. Department of Health and Human Services Office of Inspector General released a report titled “Adverse Events in Hospitals: A Quarter of Medicare Patients Experienced Harm in October 2018.”1 In 2023, Bates et al, reported on a survey of hospitals in Massachusetts that, “Adverse events were identified in nearly one in four admissions,” with adverse drug events accounting for 39.0% of all events, and surgical procedural events a close second at 30.4%.2 Clearly, we have work to do in the perioperative space.
The Anesthesia Patient Safety Foundation (APSF) approaches the challenge of preventable harm by creating collaborative relationships. Since inception, the APSF has included anesthesia professionals, leaders from industry, regulatory agencies, other health care specialties and providers, and medicolegal and insurance companies to achieve a vision “that no one shall be harmed by anesthesia care.” The APSF participates in enhancing these partnerships to resolve patient safety issues that can have devastating impacts on patients, their families, and their health care providers. In the past few years, we have broadened our relationships to includes partners such as the Patient Safety Movement Foundation, the Institute for Healthcare Improvement, the National Quality Forum, the Sepsis Alliance, and the Institute for Safe Medication Practices, to name a few.
While the APSF has been laser-focused on our vision “that no one shall be harmed by anesthesia care,” we understand that like the strands of a strong rope we should not disentangle safety from quality. The primary goal of quality health care is to ensure that patients receive the best possible care, achieving optimal outcomes, while meeting or exceeding their personal health goals. Health care and our patients do not get to quality outcomes without safety. Our vision should be entrenched throughout the experiences of the patient during the entire perioperative process, and beyond. In short, we aspire to a system without preventable harm, returning patients to their baseline or an improved state of physical, cognitive, and psychological health.
The APSF serves as a strong advocate for perioperative safety, and we continue to work the levers of action by which we turn ideas into action, and action into results. They include research, education, our Newsletter, other communication vehicles (e.g., social media), collaboration with other stakeholders in patient safety, and advocacy. With limited resources, we will continue to strategically exercise these levers to make continued progress in the fight against preventable harm. Let me highlight just a few of our many activities:
- Establishment of perioperative patient safety priorities. The APSF seeks broad input and established a list of the top ten perioperative patient safety priorities. These may be viewed at https://www.apsf.org/patient-safety-priorities/. In general, APSF’s primary activities and initiatives are focused on these priority issues, which include:
- Culture of Safety
- Clinical Deterioration
- Nonoperating Room Anesthesia
- Perioperative Brain Health
- Opioid-Related Harm
- Medication Safety
- Infectious Diseases
- Clinician Safety
- Airway Management.
- Consensus Conferences: Each year, the APSF hosts a Stoelting Consensus Conference oriented towards one of the primary priority issues. These conferences bring together patient safety advocates, anesthesia and surgical professionals, and industry and regulatory leaders to address specific topics. Examples of past conferences can be found at https://www.apsf.org/past-apsf-consensus-conferences-and-recommendations//. The 2023 conference was titled “Emerging Medical Technologies—A Patient Safety Perspective on Wearables, Big Data, and Remote Care.”Emerging medical technologies encompass a very diverse group of medical devices and software tools that are having an increasing impact on patient care and health care providers. Some are already in use, others are just on the horizon, but rapidly headed for adoption. Examples of these emerging technologies include:
- Wearable devices
- New approaches to noninvasive patient monitoring
- Closed-loop control of medical devices
- Big data tools—Artificial Intelligence including machine learning, predictive analytics
- Remote Medicine—telehealth, remote control of medical devices.
While all of these technologies may improve patient care, they are not without cost and potential risk. The goal of the Stoelting Conference 2023 was to critically examine a group of emerging technologies from the perspective of perioperative patient safety thought leaders and create recommendations that will be published.
- A manuscript with recommendations from our 2022 Stoelting Conference (Crucial Patient Safety Issues in Office-Based and Non-Operating Room Anesthesia [NORA]) has recently been published in Anesthesia & Analgesia as well as in the October 2023 issue of the APSF Newsletter.
- In November of 2022, we also held a consensus conference on perioperative hemodynamic instability. Hemodynamic instability occurs with high frequency in the perioperative period, can lead to end-organ hypoperfusion, and is associated with a range of adverse events. Yet, there are no specific recommendations to guide clinicians in identifying risks, best monitoring, specific patient thresholds for intervention, and administering effective and timely interventions. The results of the conference will be published soon and were presented at a late-breaking panel at the recent annual meeting of the American Society of Anesthesiologists. The interest among participants during the panel session was clearly palpable as there was standing room only.
- Our Committee on Technology under the leadership of Jeff Feldman, MD, has created a technology education initiative, which can be found on the APSF website. Two learning activities are currently available free-of-charge, and include 1) Low-Flow Anesthesia, and 2) Quantitative Neuromuscular Monitoring. More are in the planning stage.
We have a deeply committed group of volunteers who I am confident will rise to the perioperative health care challenges over the next decade, and the solutions that patient safety engender. We rely on your financial support to achieve our goals, and we will use our resources wisely to ensure that anesthesiology remains a leader in perioperative safety to the benefit of our patients and providers. Sometimes it is best to resist change, sometimes to align with change, but we at the APSF will be proactive to continue our work to fulfill our vision “that no one shall be harmed by anesthesia care.” It is indeed a sacred trust that we have with our patients and our goal is to further the foundation of trust on which our specialty has been built.
Dan Cole, MD, is professor of clinical anesthesiology in the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California at Los Angeles. He is also the current president of the Anesthesia Patient Safety Foundation.
The author has no conflicts of interest.
- HHS. U.S. Department of Health and Human Services Office of Inspector General. https://oig.hhs.gov/oei/reports/OEI-06-18-00400.pdf. Accessed December 13, 2023.
- Bates DW, Levine DM, Salmasian H, et al. The safety of inpatient healthcare. N Engl J Med. 2023;388:142–153. PMID: 36630622.