APSF Awards Four 1989 Patient Safety Research Grants

Jeffrey B. Cooper, Ph.D.

Four Research Grant Awards totaling nearly $135,000 were announced at the annual meeting of the Board of Directors of the Anesthesia Patient Safety

Foundation in October:

1. Charles Cote, M.D. (Harvard Medical School) “A Prospective Evaluation of Combined Pulse Oximetry and Expired Carbon Dioxide Monitoring in Anesthetized Pediatric Patients.” S 34,450

2. Randall Carpenter, M.D. (Virginia Mason Medical Center) “Identification of Patients at Risk for Developing Adverse Effects During Spinal Anesthesia.” $30,680

3. Michael Good, M.D. (University of Florida) “Can Simulation Teach Clinical Skills?” $35,000

4. David Gaba, M.D. (Stanford University School of Medicine) “A Model Course in Handling lntra-operative Critical Incidents: Training and Practice to Prevent Anesthetic Mishaps.” $34,615

Dr. Cote will be building upon his earlier work on studying the efficacy of pulse oximetry in the pediatric population. He plans to contrast the success in detecting critical events by the combination of pulse oximetry and capnography versus the absence of these two monitors. Patients will be randomized into two groups and, for the “unmonitored” patients, a trained observer win view a monitor turned away from the anesthetists, document events, and intervene according to predetermined criteria. The objectives are to examine the efficacy of the combination of the two monitors, to examine the types of events diagnosed by each, and to assess if one monitor may be superior to the other.

Dr. Carpenter’s research will attempt to identify predictors of patients who are at increased risk to develop adverse side effects or complications of spinal anesthesia. A research nurse will track patient complications and the characteristics of patients who do and do not experience adverse side effects will be compared.

Dr. Good, using an anesthesia simulator successfully exhibited at several national meetings, will examine how well anesthesiology residents learn clinical skills with this teaching aid. Specifically, the investigators will test the hypothesis that residents learning on this simulator are better able to detect and correct adverse situations in the absence of monitoring instrumentation. They are addressing the concern that residents may be unable to rely solely on clinical skills if their training incorporates monitoring instrumentation. An improved patient mannequin will be a key ingredient in this effort.

Using a simulation mannequin developed by his group at Stanford, Dr. Gaba will develop and demonstrate an intensive training course for trainees and practitioners on how to prevent critical incidents during anesthesia or respond to them before patient safety is compromised. The remarkably realistic anesthesia simulator will provide the environment in which to understand and practice specific clinical skills. They will examine how well participants learn new skills from the course and whether these subjects perceive this form of training as superior to traditional continuing medical education as a means to achieve greater patient safety in anesthesia.

This is the third consecutive year that the APSF has supported investigations directed toward enhancing patient safety.

These grant awards illustrate some major foci of patient safety research in anesthesia examining the effectiveness of monitoring modalities, developing anesthesia simulators to improve skills and to examine patterns of error and identification of patterns associated with anesthesia complications and adverse outcomes.

The Anesthesia Patient Safety Foundation awards grants annually for research and patient safety. Awards are based on competing applications. An announcement of 1990 application details and deadline appears in this issue.

Dr. Cooper is Director of Anesthesia Technology, Department of Anesthesia, Massachusetts General Hospital and the new chairman of the APSF Committee on Scientific Evaluation.