The Anesthesia Patient Safety Foundation (APSF) is pleased to report that it continues to attract outstanding applications for funding. The scope of research areas continues to evolve, and this year the committee has made significant changes to the application process, while increasing the amount of research awards. The educational focus of APSF continues to include innovative methods of education and training to improve patient safety, development of educational content with application to patient safety, and development of testing of educational content to measure and improve safe delivery of perioperative anesthetic care.
The year 2004 witnessed several significant changes in the APSF: the website underwent a major redesign and with that, all of the applications to APSF starting with the funding cycle 2006 (application deadline of June 2005) will be accepted only electronically. The applications, as well as all the attachments, will be uploaded to the new APSF redesigned website, a process that will facilitate the application review by members of the Scientific Evaluation Committee, improve the timeliness of response, and facilitate transmission of reviewer feedback to the applicants.
Also of significance for the APSF grant application process is the increase in funding to $75,000 per accepted application. As in the previous funding cycle, and in addition to the Clinical Research and Education and Training content that is the major focus of the funding program, APSF continues to recognize the patriarch of what has become a patient safety culture in the United States and internationally, and one of the founding members of the foundation: Ellison C. “Jeep” Pierce, Jr., MD. The APSF Scientific Evaluation Committee continues to designate each year one of the funded proposals as the recipient of the prestigious Ellison C. Pierce, Jr., MD, Research Award. The award carries with it an additional, unrestricted prize of $5,000.
For the year 2004 (projects to be funded starting January 1, 2005), 4 grants were selected for financial support by the APSF Scientific Evaluation Committee (for names of committee members, please refer to the list in this issue). The APSF Scientific Evaluation Committee members were pleased to note that they reviewed 31 applications in the first round, 12 of which were selected for final review at the American Society of Anesthesiologists’ (ASA) annual meeting in Las Vegas, NV. As in previous years, the grant submissions addressed areas of high priority in clinical anesthesia. The major objective of APSF is to stimulate the performance of studies that lead to prevention of mortality and morbidity from anesthesia mishaps. A particular priority continues to be given to studies that address anesthetic problems in healthy patients, and to those studies that are broadly applicable and promise improved methods of patient safety with a defined and direct path to implementation into clinical care.
The APSF Scientific Evaluation Committee met during the ASA annual meeting on October 23, 2004, in Las Vegas, NV, for final evaluation of the proposals. Of the 12 finalists, the members of the APSF Scientific Evaluation Committee selected 4 awardees:
Joseph J. Quinlan, MD — Associate Professor, Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA. His grant proposal is entitled “Using Whole Task Human Simulation to Improve the Difficult Airway Management Skills of Practicing Anesthesiologists.” The objective of this proposal is to define a valid, reliable, and practical method of assessing competency in difficult airway management by practicing anesthesiologists.
Management of the difficult airway by practicing anesthesiologists is, fortunately, a low-frequency event, but one that carries with it significant patient morbidity and even mortality. Despite the great progress that has been made in the last decade in the armamentarium of equipment and techniques available to clinicians, and the addition of protocols and algorithms such as the ASA’s “Guideline for Management of the Difficult Airway,” there has been little formal study of the impact that these techniques, protocols, and algorithms have had on the frequency of morbidity and mortality of patients with difficult airways. Additionally, the process by which anesthesiology residents are trained in the management of the difficult airway, along with the associated airway management techniques, is highly variable, with the traditional “apprenticeship” method predominating.
The specific aims of this grant are to validate a whole-task, simulation-based evaluation method for determining difficult airway management competency; to use a described simulation evaluation method and assess the baseline skill levels of a large group of practicing anesthesiologists in difficult airway management; to objectively assess the effectiveness of instructing practicing anesthesiologists and clinically applying the ASA Difficult Airway Management Guidelines and its associated airway management techniques; and to describe a simulation evaluation method and assess the decay rate of difficult airway management skills over a subsequent 1- to 3-year period in order to determine the appropriate retraining period to maintain competency in airway management skills.
The proposal has significant patient safety implications since difficult airway management remains one of the leading causes of anesthetic deaths and malpractice claims in the United States. Developing a valid, reliable, and practical method for assessing competency in difficult airway management has significant patient safety implications and offers a premise for improved educational programs and evaluation methodologies. Other personnel listed in Dr. Quinlan’s research proposal include Ryan Romeo, MD, coinvestigator; Thomas Dongilli, simulation specialist; and John Schaefer, MD, simulation expert.
In addition to receiving the requested funding of $65,000 for this project, Dr. Quinlan is also the recipient of the Ellison C. Pierce, Jr., MD, Research Award, which consists of an additional, unrestricted grant of $5,000.
Christopher M. Bernards, MD — Professor, Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA; and Department of Anesthesiology, Virginia Mason Medical Center; Seattle WA. His grant proposal is entitled “The Respiratory Effects of Opioids in Patients with Documented Obstructive Sleep Apnea.” The objective of this proposal is to measure all standard indices of obstructive sleep apnea (OSA) severity and to determine whether opioid administration worsens airway obstruction in subjects with OSA.
The specific aims of this proposal are to test the hypothesis that opioid analgesics increase the number and severity of episodes of airway obstruction in patients with documented OSA; to test the hypothesis that pain partially offsets the respiratory impact of opioid analgesics in patients with OSA; and to test the hypothesis that continuous positive airway pressure will effectively reverse the increased obstruction that occurs in OSA patients receiving opioid analgesics.
This proposal has significant patient safety implications, as it will begin to clarify the appropriate perioperative care of OSA patients by characterizing the respiratory effects of opioids in this at-risk patient population. Other personnel listed in Dr. Bernard’s research proposal include Matthias Lee, MD, coinvestigator.
Geordie P. Grant, MD — Associate Professor, Department of Anesthesiology, UMDNJ-New Jersey Medical School, Newark, NJ. Her grant proposal is entitled “The Effect of Position on Intraocular Pressure and Ocular Perfusion during Prone Spine Surgery.” The objective of this clinical proposal is an interdisciplinary effort to better define the factors that are responsible for ischemic optic neuropathy (ION) hypoperfusion syndrome during prone spine surgery.
The specific aims of this proposal are to determine the relationship between intraocular pressure and retinal oximetry as a measure of perfusion. The protocol will then compare the effect of a neutral head position to a 15-degree head-up tilt position on intraocular pressure and retinal oximetry in prone patients undergoing spine procedures lasting more than 5 hours. In addition, the investigators will test other factors that may impact on the incidence of ischemic optic neuropathy, such as preoperative hematocrit values, length of operation, mean arterial blood pressure during the operation, amount of blood loss, amount of serum hemoglobin and hematocrit levels, and the volume of crystalloid infused during the operation.
This proposal has significant patient safety implications, as it proposes to investigate a rare, but potentially devastating, intraoperative complication, that of ischemic optic neuropathy and postoperative blindness. Other personnel listed in Dr. Grant’s research proposal include Roger Turbin, MD, Department of Ophthalmology, as coinvestigator; and Ben Szirth, PhD, Assistant Professor of Research, who will provide the ophthalmic measuring devices and the technical expertise with retinal oximetry.
Samsun (Sem) Lampotang, PhD — Associate Professor with Tenure, Department of Anesthesiology, University of Florida, Gainesville, FL. His education and training grant proposal is entitled “Development and Evaluation of a Web Simulation and Workbook for the Anesthesia Machine Pre-Use Check.” The objective of this proposal is to address a very common omission, that of the failure to properly check the anesthesia machine prior to induction of anesthesia.
Dr. Lampotang proposes to implement a web-based, widely distributed simulation of the pre-use check that can be accessed without charge at the virtual anesthesia machine website. The investigator also proposes to create and make available, free of charge, a companion set of self-paced, structured exercises on the previous check that will become the second chapter of the anesthesia machine workbook. The evaluation component will be designed to answer 3 fundamental questions regarding the proposed educational material: its effectiveness, its usefulness, and its ability to alter anesthesia practice.
This proposal has significant patient safety implications, as multiple studies over the last 2 decades have shown that improper execution of the anesthesia machine pre-use check, as well as poor compliance with performing a pre-use check before induction of general anesthesia is one of the most common factors implicated in critical incidents. Other personnel listed in Dr. Lampotang’s research proposal include David Lizdas, coinvestigator; Dietrich Gravenstein, MD, consultant; and Joachim S. Gravenstein, MD, consultant.
The members of the APSF Scientific Evaluation Committee wish to congratulate all of the investigators who submitted their work to APSF, whether or not their proposals were funded. We hope that the high quality of the accepted proposals and the important findings that will undoubtedly result from completion of these grant proposals will serve as a stimulus for others to submit research grants that will benefit all patients and our specialty.
Sorin J. Brull, MD, is chair of the APSF Scientific Evaluation Committee and Professor of Anesthesiology, Mayo Clinic College of Medicine, Jacksonville, FL.