Three patient-safety research projects were awarded grant funding fromthe APSF for 1997 at the October annual meeting held in conjunctionwith the ASA meeting in New Orleans. Information about the programand how to apply is available in the separate boxed announcement inthis issue.
For the second consecutive year, there were an unusually large number of applications to the APSF for patient-safety-related projects. Although the 30 applications received by the June 15 deadline were down from last year’s all-time record of 47, this still represents the second largest number of applications in the 11-year history of the program.
Several interesting new topic areas were included among the proposals and the unusually competitive project topics. Of the 30 reviewed in the first round, 11 were selected for the final discussions and rankings at the meeting of the APSF Committee on Scientific Evaluation (See listing of APSF officers and committees on page 47 for a list of reviewers). The three selected for funding are summarized below. The APSF extends congratulations to the awardees. Further, recognition goes to all of the applicants, all of whom put great effort into preparing their applications. The APSF hopes that all are successful in finding paths to do their projects. Again this year, feedback about the application process and the deliberations will be available to all unfunded applicants who request it.
The funded projects are:
Scientific Evaluation of Anesthesiologist Performance: Further Validation and Study of the Effects of Sleep Deprivation and of Intraoperative Reading
Matthew B. Weinger, M.D., Department of Anesthesiology, University of California, San Diego
With his second APSF grant, Dr. Weinger will continue to examine issues of human performance in anesthesia practice and their potential patient safety implications. Using task analysis and workload indicators he developed, a series of experiments will be conducted in the clinical environment and in a realistic simulation environment to examine the effects of sleep deprivation and fatigue on performance. A controlled comparison of real-time and off-line video analysis of routine anesthetics will test the validity of the measurement methods and the effect of observers on the real-time assessments. These measurement techniques will later be used to study anesthesiologist performance in real and simulated anesthesia cases. The effects of sleep deprivation will be measured using task analysis in simulated cases in the Stanford Anesthesia Simulator and during actual cases in a real OR. Related experiments will examine how reading during anesthesia administration may affect task characteristics and vigilance.
Detection and Prevention of Acute Urinary Retention in Ambulatory Surgical Patients
D. Janet Pavlin, M.D., Department of Anesthesia, University of Washington, Seattle
Dr. Pavlin’s study will test an algorithm for treating inability to void after outpatient surgery. The topic is an example of the interaction between patient safety issues and the widespread strenuous efforts to improve efficiency in surgical settings and thus reduce facility costs. The hypothesis is that patients defined as being at low risk for urinary retention can be discharged safely, without having voided, if bladder volume is low-as demonstrated by an ultrasound measurement prior to discharge. The relationship between perioperative IV fluid administration and urinary retention in low-risk patients will also be examined. Further, the use of an ultrasound device to manage patients at high risk for urinary retention will be evaluated. Another aim of the project is to determine if persistent postoperative problems due to development of an atonic bladder after significant stretching can be prevented in all patients by early intervention at the onset of retention, again using ultrasound monitoring of the bladder volume.
Ulnar Nerve Injury in the Perioperative Period: Role of Arm Position and Nerve Compression
Richard C. Prielipp, M.D., John F. Butterworth, IV, M.D. Robert C. Morell, M.D., Robert L. James, M.S., Department of Anesthesia, Bowman Gray School of Medicine
Although perioperative nerve injuries constitute 15% of anesthesia-related malpractice litigation claims, the exact mechanism of these injuries remains undefined. Because it lies in a rigid but superficial condylar groove at the elbow, the ulnar nerve is particularly susceptible to external pressure. This project of Dr. Prielipp and colleagues is aimed at: (1) determining the magnitude and duration of applied external pressure required to disrupt clinical and physiologic (nerve conduction) ulnar nerve function; (2) measuring external pressure that is spontaneously exerted on the ulnar nerve during varying degrees of pronation and supination and of abduction of the arm, simulating typical arm positions in the OR; and (3) determining if there is a difference in the susceptibility of ulnar nerve to external pressure based on gender. Studies will be completed initially on awake, normal volunteers with investigations eventually extended to patients receiving anesthesia. The studies are intended to expand the understanding of mechanisms of ulnar nerve injury and confirm or refute current recommendations for safe positioning of the arms during anesthesia and surgery.
Dr. Cooper, Health Partners (Mass. General & Brigham/Women’s Hospitals), Boston, is chairman of the APSF Committee on Scientific Evaluation.