Volume 6, No. 4 • Winter 1991

APSF President Assesses 1991 Safety Developments

Ellison C. Pierce, Jr., M.D.

The Anesthesia Patient Safety Foundation completed its sixth year in October. Among its interests, funding safety research and providing the only publication dedicated to disseminating knowledge of anesthesia patient safety continue to be primary.

Another major undertaking for the Foundation during the year was joint sponsorship with the Food and Drug Administration of an international, multidisciplinary conference targeting human error in anesthesia. Out of the meeting came a set of broad research goals examining methods of improving performance in anesthesia practitioners and a decision to hold an open scientific meeting in 1993 to discuss these issues further.

Anesthesia Simulators

Also important among the APSF goals is hastening the development of anesthesia simulators for education and training. The reasons for this are several. One primary concern is the new opportunity for teaching technical skills and crisis management in a realistic simulation environment rather than with a live patient. In addition, such an approach allows familiarity with numerous difficult anesthesia crises rather than the select few that occur for any single individual during a three-year residency training program. Jeffrey R Cooper, Ph.D., has recently reviewed the role of realistic anesthesia simulators. (1)

One of the most rapidly expanding safety areas in American medicine, about which all anesthesia personnel should be aware, is the development of practice parameters guidelines. A widespread consensus among professional and lay groups knowledgeable about current medical management sees these parameters as vehicles for improving over-all patient care (reducing inappropriate care), making more effective use of resources, and advancing methodologies in clinical decision making. It is estimated that some 1,800 practice parameters have been published in recent years by a number of organizations, including specialty societies, managed care plans, academic medical centers, medical insurance companies and the Federal Government. Of special note was the establishment by Congress two years ago of the Agency for Health Care Policy and Research (AHCPR), with funding for 1990 of some $126,000,000 and for 1992, some $221,000,000. A major undertaking for this agency is the writing of practice guidelines.

It has been my view for many years that the primary developers of such parameters should be physician groups. The American Medical Association (AMA) fortunately has taken the lead, among medical organizations, in attempting to analyze, coordinate and direct the enormous amount of activity in this arena by providing thoughtful guidance to the many interested parties. To do this, the AMA has established a Practice Parameters Forum, to which I am the American Society of Anesthesiologists (ASA) representatives, and a Practice Parameters Partnership, to which James F. Arens, M.D., is ASA representative. Clearly, if physicians do not take the responsibility for developing guidelines, government agencies and other third parties will do it for us.

ASA Practice Parameters

With this reasoning, the ASA has recently appointed an Ad Hoc Committee on Practice Parameters that has now met several times and established a consultative relationship with Steven H. Woolf, M.D., M.P.H., a well known authority on the subject of practice guidelines. The Committee has appointed two Task Forces, one dealing with the parameters involved in pulmonary artery monitoring, chaired by Michael F. Roizen, M.D., and one with the difficult airway, chaired by Robert A. Caplan, M.D. Both Task Form hope to complete their undertakings in time for consideration by the ASA Board of Directors in August, 1992, and approval or disapproval by the ASA House of Delegates in October, 1992. Dr. Woolf has provided an excellent review of the subject that I urge all anesthesia practitioners to stud V.2

Lastly all of us on the APSF Executive Committee and Board are pleased to see the Foundation growing in membership among all anesthesia practitioners as well as diverse individuals in many allied fields. The other medical specialty areas in American medicine continue to admire the anesthesia patient safety movement.

Ellison C. Pierce, Jr., M.D. APSF President


  1. Cooper JB: Realistic anesthesia simulators. ASA Newsletter 1991; 55:12-15.
  2. Woolf SH: Practice guidelines: A new reality in Medicine Arch Intern Med 1990; 150:1811-1818.