The Anesthesia Patient Safety Foundation (APSF) is pleased to report that it continues to attract outstanding applications for funding. The educational focus of APSF includes 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 application process continues with an electronic, online submission format introduced last year. The applications, as well as all the required attachments, are uploaded to the newly redesigned APSF website (www.apsf.org), a process that facilitates the application review by members of the Scientific Evaluation Committee, improves the timeliness of response, and facilitates transmission of reviewer feedback to the applicants. The Scientific Evaluation Committee members continue to modify and perfect the electronic application and review process.
Also of significance for the APSF grant application process was the increase in funding to $75,000 per accepted application introduced in 2004. In addition to the Clinical Research and Education and Training content that is the major focus of the funding program, the 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 1 of the funded proposals each year as the recipient of this prestigious nomination, the Ellison C. Pierce, Jr., MD, Research Award. The award carries with it an additional, unrestricted prize of $5,000. New this funding cycle is the addition of the APSF/Anesthesia Healthcare Partners Research Award, made possible by an unrestricted grant from Anesthesia Healthcare Partners (AHP).
For the year 2005 (projects to be funded starting January 1, 2006), two grants were selected for funding 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 21 applications in the first round, 8 of which were selected for final review at the American Society of Anesthesiologists (ASA) Annual Meeting in Atlanta, Georgia. As in previous years, the grant submissions addressed areas of high priority in clinical anesthesia. 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 to implementation into clinical care. Additionally, the APSF is encouraging the study of innovative methods of education and training to improve patient safety.
The applications that the Scientific Evaluation Committee received this year covered a variety of topics:
- The cost-effectiveness of reducing the incidence of retained surgical sponges.
- The investigation of a neuromuscular blocker advisory system utilizing adaptive process control technology.
- Improving patient safety during epidural needle insertion by creating an educational outline and objective assessment of skills and judgment.
- Prediction of respiratory compromise during patient-controlled analgesia by heuristic modeling of continuous oximetry and capnography.
- An investigation of the use of electronic patient records to determine independent intraoperative predictors of perioperative mortality.
- The detection of anaerobic metabolism during anesthesia using indirect calorimetry.
- Evaluation of lingual tonsil hyperplasia during the preoperative endoscopic exam.
- Assessment of resident performance during obstetric anesthesia using the human patient simulator.
- The effects of depth of sedation on long-term functional outcome and postoperative delirium in elderly orthopedic patients.
- An evaluation of the severity of illness as a predictive model of outcomes.
- The evaluation of an interdisciplinary OR team in a malignant hyperthermia simulation scenario to promote improved outcome.
- The analysis of anti-coagulant effects of three times daily (TID) low-dose heparin regimen on removal of epidural catheters in surgical patients.
- The investigation of phenotyping the susceptibility to malignant hyperthermia using a microdialysis technique.
- The evaluation of vocal cord immobility due to recurrent laryngeal nerve paresis during anterior cervical spine surgery.
- An investigation of the association between anesthesiologist age and incidence of malpractice litigation.
- The development of a perioperative dental risk recognition and prevention program.
- The evaluation of the acceptance of a novel syringe-catheter connector system for spinal and epidural administration of medication.
- The effectiveness of perioperative beta-blockade in morbidly obese patients in reducing intraoperative anesthetic requirements.
- The investigation of the prolonged QT syndrome in the perioperative period.
- The development of digital video technology to improve the education, proficiency, and safety of anesthesia residents performing invasive clinical procedures.
The APSF Scientific Evaluation Committee met during the ASA annual meeting on October 22, 2005, in Atlanta for final evaluation of the proposals. Of the 8 finalists, the members of the APSF Scientific Evaluation Committee selected 2 awardees:
Melanie C. Wright, PhD – Assistant Professor, Department of Anesthesiology, and Human Simulation and Patient Safety Center, Duke University, Durham, NC. Her grant submission is entitled, “Objective Measures of Performance in Simulated Anesthesia: A Comparison of Novices and Experts.”
The use of human patient simulators in anesthesiology training and assessment has been limited by the lack of objective, validated measures of human performance. Such measures are necessary if simulators are to be used to evaluate the skills and training of anesthesia providers and teams, or to evaluate the impact of new processes or equipment design on overall system performance. There are 2 main goals of this project: the first is to quantitatively compare objective measures of anesthesia provider performance with regard to their sensitivity to both provider experience and simulated anesthesia case difficulty. The authors plan to compare previously validated measures of anesthesia provider performance to 2 objective measures that are relatively novel to the environment of anesthesia care: an objective measure of provider situation awareness, and a measure of providers’ eye scan patterns. The second goal of this project is to qualitatively evaluate the situation awareness and eye tracking data to identify key determinants of expertise in anesthesia providers. These determinants of expertise may then be used to further enhance objective measures of performance as assessment tools, and to improve training of anesthesia providers.
The results of this study are directly applicable to the assessment of anesthesia providers’ ability and to training, and will ultimately lead to improved patient care and safety. This study proposes to validate 2 objective measures of performance that may provide better scalability with respect to assessing multiple performers. In addition, situation awareness and eye tracking measures may provide improved means for assessing the underlying dynamic knowledge of care providers and their performance with respect to accessing relevant information. The validation of these measures may also serve to support efforts in the design and evaluation of anesthesia displays for their safe and effective use by care providers.
Perhaps more importantly, this study provides a basis for identifying specific determinants of expertise in anesthesia. Through qualitative evaluation of situation awareness query responses and eye tracking data, the authors propose to identify specific indicators that are reflective of skill acquisition in anesthesia. Such information will be useful in enhancing training of anesthesia providers.
Investigators listed in Dr. Wright’s research proposal include Jeffrey M. Teakman, MD, Jonathan B. Mark, MD, and Mark Stafford-Smith, MD. Other personnel include Eugene W. Hobbs, Laboratory Technician; Bryan Andregg, Analyst Programmer; and Barbara G. Phillips-Bute, Statistician.
In addition to receiving the requested funding of $74,959 for this project, Dr. Wright is also the recipient of the Ellison C. Pierce, Jr., MD, Research Award, which consists of an additional, unrestricted grant of $5,000.
Martin J. London, MD — Professor of Clinical Anesthesia, Department of Anesthesiology, University of California, San Francisco, San Francisco, CA. His grant proposal is entitled, “Perioperative Pharmacologic Prophylaxis for Cardiovascular Events in the Department of Veterans Affairs: A Pharmacoepidemiologic Pilot Project.”
The objective of this proposal is to develop a pharmacoepidemiologic study of the association of cardiovascular pharmacologic prophylaxis with perioperative and 1-year outcomes after major non-cardiac surgery in the Department of Veterans Affairs (DVA) population. Outpatient and inpatient prescription data from the system-wide Pharmacy Benefits Management–Strategic Healthcare Group for beta-blockers, statins, calcium channel blockers, alpha-2 agonists, and antiplatelet agents will be matched with risk factors, surgical details, and perioperative outcomes (myocardial infarction, cardiac arrest, pulmonary edema, stroke, all cause mortality, and length of stay) for patients undergoing major general, vascular, thoracic, urologic, neurosurgical, and orthopedic procedures in 4 fiscal years (2002–2006) collected by the National Surgical Quality Improvement Program (NSQIP). One-year all-cause mortality will be determined using the DVA’s administrative death benefits database (BIRLS). The authors will study approximately 100,000 major surgical cases performed at approximately 123 hospitals. Propensity scoring will be used to adjust for medication prescribing biases, followed by risk adjustment using validated NSQIP methodology. Logistic regression models will be developed using patient and hospital covariates along with drug use (considering duration of therapy, dose, and class) to determine associations with the primary (perioperative mortality and outcomes) and secondary (1-year mortality and hospital length of stay) outcomes. This pilot study will facilitate a greater understanding of current practices in a high-risk surgical population, and will lay the groundwork for larger scale funding from federal agencies. This project has a particular application to patient safety, as it will better delineate specific areas in which focused, randomized controlled trials of particular drugs may be logistically practical and economically feasible. The collaborators listed in Dr. London’s proposal are William G. Henderson, PhD, Co-Director of the NSQIP from the Denver Data Analysis Center, and Francesca Cunningham, PharmD, research coordinator.
In addition to receiving the requested funding of $75,000 for his project, Dr. London is the recipient of the inaugural APSF/Anesthesia Healthcare Partners Research Award.
On behalf of APSF, the members of the 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 proposals and the important findings that will undoubtedly result from completion of these projects will serve as a stimulus for other investigators 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 at the Mayo Clinic College of Medicine, Jacksonville, FL.