The Anesthesia Patient Safety Foundation (APSF) is pleased to report that it continues to attract outstanding applications for funding. The scope of investigation areas continues to evolve, and this year the committee expanded the educational focus to include innovative methods of education and training to improve patient safety, development of educational content with application to patient safety, and development or testing of educational content to measure and improve safe delivery of perioperative anesthetic care.
This year 3 grants were selected for funding by the APSF Scientific Evaluation Committee (SEC; for names of committee members, please refer to the list on page 61). As in previous years, the award amount is $65,000. The SEC members were pleased to note that the committee reviewed 30 applications in the first round, of which 12 were eligible for final review at the ASA Annual Meeting in San Francisco. As in previous years, the grant submissions addressed areas of high priority. The major objective of the 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 toward implementation into clinical care.
In addition to the research and educational content that is the major focus of the funding program, APSF also recognizes 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 thus designates each year one of the funded proposals as the recipient of this prestigious nomination, the Ellison C. Pierce, Jr. Award. This award carries with it an additional, unrestricted prize of $5,000.
The applications this year covered a variety of topics: the value of C-reactive protein in cardiovascular risk stratification; the use of ultrasound for central venous cannulation; the role of prehabilitation in postoperative recovery; the reliability and safety of paresthesia-inducing regional blocks; the hemodynamic consequences of preoxygenation; the detection and elimination of artifacts in electronic record keeping; the use of virtual reality for regional anesthesia; the formation of toxic propofol intermediates and its metabolic polymorphism; the use of a web-based anesthesia machine pre-use check; the safety of analgesic prescription practice upon hospital discharge; the effects of bright lights and caffeine on patients’ alertness status; B-cell calcium signaling as a diagnostic indicator of malignant hyperthermia; the role of musical stimuli in the design of auditory alarms; the impact of the preoperative process on perioperative morbidity; the development of a pediatric emergence agitation scale; the effect of education on catheter-related bloodstream infections; the use of monoclonal antibodies for neuromuscular block reversal; the effect of carbon dioxide injection on recovery time from inhalational agents; the role of normoglycemia in cardiac surgery patients; the effect of neurosurgical patient positioning on ventilator-associated pneumonia; the effect of depth of hypnosis monitoring on patients undergoing non-cardiac surgery; the effects of body inclination on intraocular pressure in the prone position; the development of a novel sedation/pain scale and treatment algorithm; the assessment and postoperative complications in obstructive sleep apnea patients; the effectiveness of an on-line interactive program for learning by medical students; and the safety of regional anesthesia.
The APSF Scientific Evaluation Committee met during the ASA Annual Meeting on October 11, 2003, in San Francisco for final evaluation of the proposals. Of the 12 finalists, the members of the APSF committee selected 3 awardees:
Judith A. Clair, PhD, is Associate Professor, Department of Organization Studies, Carroll School of Management, Boston College. Her grant proposal is entitled “Identifying Optimal Debriefing Strategies for Educating Anesthesiologists Using Simulated Critical Incidents.” The objective of this proposal is to systematically describe the process of post-crisis facilitated debriefing by analyzing and coding videotape-recorded debriefings of realistic, simulated anesthesia crises from a number of centers currently practicing this educational modality. The investigators will also conduct a preliminary assessment of the effectiveness of debriefing based on participant assessment of its effectiveness. The results of this research will lead to a more thorough understanding of debriefing methodology, and will derive data on debriefing’s effectiveness as a mechanism to learn about managing anesthesia crises. With a more complete characterization of debriefing and data concerning its efficacy, simulation centers and their faculty will be more effective in educating anesthesiologists as to how best to respond when critical events occur.
This proposal has significant patient safety implications, as it will offer objective criteria and methodologies for teaching anesthesia crisis management. Other personnel listed in Dr. Clair’s proposal include co-investigator Ronald L. Dufresne, BS, PhD (Candidate), and consultants Simon Gelman, MD, PhD; Jeffrey B. Cooper, PhD; Daniel B. Reamer, PhD; and Robert Simon, EdD.
In addition to receiving the requested funding of $65,000 for this project, Dr Clair is also the recipient of the “Ellison C. Pierce, Jr., MD, Award,” which consists of an additional, unrestricted grant of $5,000.
Patricia Fogarty-Mack, MD, is Associate Professor of Clinical Anesthesiology, Department of Anesthesiology, Weill Medical College of Cornell University, New York. Her grant proposal is entitled “The Effect of Timolol on Intraocular Pressure and Postoperative Vision in Patients Undergoing Spine Surgery.” The objective of this proposal is to determine whether preoperative administration of timolol can attenuate the increase in intraocular pressure associated with prone positioning in a sustained fashion throughout major spine surgery. A second aim of this study is to determine whether preoperative timolol administration affects the incidence of other postoperative visual disturbances, namely changes in visual acuity and visual fields. This proposal has significant patient safety implications, since postoperative vision loss is a rare, but catastrophic complication that has been reported following general anesthesia for major spine surgery in the prone position.
Dr. Fogarty-Mack’s co-investigator is Dr. Charles Cole, Assistant Professor of Ophthalmology, who will perform all ophthalmologic evaluations.
Melanie C. Wright, PhD, is Assistant Professor, Department of Anesthesiology, Human Simulation and Patient Safety Center, Duke University, North Carolina. Her grant proposal is entitled “Effect of Time of Day and Surgery Duration on Adverse Events in Anesthesia.” The effects of fatigue on clinical performance are measurable, yet these decrements have not been clearly linked to adverse clinical outcomes following surgery. This research proposes to evaluate existing perioperative data from over 86,000 surgical procedures for two possible sources of adverse events in anesthesia, namely, the time of day of the surgical procedure and the duration of surgery itself. This proposal has major implications on patient safety, as it may ascertain those factors that are most likely to lead to adverse outcomes in surgical patients.
Dr. Wright’s co-investigator is Jeff Taekman, MD, and her consultants are Terrence Breen, MD; Katherine Grichnik, MD; Jonathan Mark, MD; Bryan Andregg; Barbara Phillips-Bute, PhD; Iain Sanderson, MD; and Bill Gilbert.
The members of the APSF Scientific Evaluation Committee wish to congratulate all of the investigators who submitted their work to APSF this year, 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 proposals will serve as a stimulus for others to submit research grants that will benefit all patients and our specialty.
Dr. Brull is the Chair of the APSF Committee on Scientific Evaluation.