Three research grants were chosen for funding from among twenty-seven applications reviewed by the APSF Committee on Scientific Evaluation. The total amount of the awards was $175,507. The Committee also decided on several modifications to the guidelines and conditions of awards for grants to begin in 1993.
Safety of Pediatric Postoperative Analgesia to be Studied
Dr. Charles Berde, Director of the Pain Treatment Service of the Children’s Hospital in Boston, will lead a multi-center study of the safety and risk factors associated with postoperative regional analgesia for pediatric patients. The study group collected pilot data retrospectively from approximately 9,000 regional anesthesia administrations and examined convulsions, cardiovascular instability, and severe respiratory depression among patients receiving postoperative analgesia. They will further analyze their existing database and expand it with prospective reports of adverse events reported from the 13 participating institutions. The study group was assembled with approval of the Society for Pediatric Anesthesia and the American Academy of Pediatrics Section on Anesthesiology. Using the pooled data, the group hopes to reach a consensus on guidelines for dosing schedules for epidural infusions of bupivicaine, fentanyl, morphine and hydromorphone.
Effect of Long Work Hours on Performance and Learning Will be Examined
Dr. Lance Lichtor and colleagues of the Department of Anesthesia and Critical Care at the University of Chicago will study the effects of long work hours on the ability of anesthesia and surgical providers to monitor multiple sources of information and to learn and retain information after 24-hour (anesthesiologists) and 36-hour (surgeons and pediatricians) work shifts. ICU nurses will be used as control subjects. Learning and recall will be tested via several standard psychological testing methods. Performance on monitoring tasks will be measured in a realistic simulation environment set up to mimic the operating room or ICU setting. This aspect of testing will use the simulation environment developed at the University of Florida, Gainesville. By using a simulation environment for testing, offering monetary incentives to volunteers and documenting alcohol, caffeine and other drug usage, the investigators hope to provide more objective information that has been available from previous studies on this controversial topic. Further, and, by comparing both younger and older subjects, the effects of age on task performance of medical providers may also be revealed.
Systems Engineering Applied to Anesthesia Tasks in Interdisciplinary Study
Dr. M. Elisabeth Pate-Cornell, Associate Professor of Industrial Engineering at Stanford University, will apply the technique of probabilistic risk assessment PRA) to develop a quantitative risk analysis model )r anesthesia and assess the effects of organizational actors on the risk of accidents. She has previously ad success in using PRA to study such situations s off-shore oil platform and space orbiters. Along with her colleagues in the Industrial Engineering Department and anesthesia consultants, she will apply the same general accident models they have sod m industrial domains and develop intermediate models, creating “fault trees” and applying stochastic principles to estimate the risk of various outcomes caused by system failures. The concept requires knowledge of probabilities of various possible events, which will be estimated from published studies or expert opinion. This research represents another venture into interdisciplinary risk analysis research via the APSF grants program.
Changes in the APSF Grant Program
There have been a few modifications to the grants program that will apply to applications for funding beginning January, 1993 (due by June 15, 1992 see announcement on page 3 7). The total amount of each award will be limited to S 50, 000, but projects will be permitted to extend for up to two years. Although the top applications represented interesting approaches to patient safety, the entire set of 27 applications was felt by the committee to be lacking in overall quality and innovation. The new guidelines include additional suggestions to applicants, urging that expert advice be sought for proposal preparation and experimental design. Once again, applicants are encouraged to refer to previous articles in the APSF Newsletter, which have described the type of ideas given priority and the problems which lead to lack of success (Volume 4, No. 4, December, 1989 and Volume 5, No. 4, 1990).
Dr. Jeffrey B. Cooper, Massachusetts General Hospital, Boston, is the Chairman of the APSF Committee on Scientific Evaluation. Other members of the committee are listed on page 47.