As President of the Anesthesia Patient Safety Foundation (APSF), it is my privilege to report annually on the activities of the foundation during the past calendar year. I am pleased to report that 2005 has been a rewarding and successful year including advocacy of safety initiatives intended to fulfill our mission that no patient shall be harmed by anesthesia.
Audible Information Signals
I am most pleased to report that the APSF “audible alarms” initiative has reached a successful outcome that can only be viewed as the “right thing to do for our patients.” As a result of your foundation’s efforts, both the American Association of Nurse Anesthetists and the American Society of Anesthesiologists have added audible alarms from pulse oximetry and capnography to their monitoring standards. The evidence was compelling that this new monitoring requirement (standard) will save lives and improve patient safety. Without the APSF advocating this change, it is unlikely that audible alarms would have been added to the monitoring standards. I doubt if any one of us would knowingly fly on an airplane on which the pilot silenced the audible alarms; our patients deserve no less.
Carbon Dioxide Absorbent Desiccation Conference
The report of the “Carbon Dioxide Desiccation Safety Conference” convened by the APSF in April 2005 was published in the Summer 2005 APSF Newsletter. This conference was attended by representatives of industry (carbon dioxide absorbent manufacturers, machine manufacturers, producers of volatile anesthetics) along with clinicians, with the single goal of creating a consensus statement for dissemination to all anesthesia professionals. The recommendations of the conference demonstrate the APSF’s role in providing safety information to the anesthesia professional responsible for care of patients during anesthesia and surgery.
A unique value of the APSF is its ability to bring together members of industry, nursing, and medicine under a neutral umbrella without the issue of restraint of trade or conflict of interests that would be present in other environments. The carbon dioxide absorbent conference was a rewarding example of this unique aspect of the APSF.
An evolution of the APSF Long-Term Outcome conference in September 2004 is the APSF Task Force chaired by Marcel E. Durieux, MD. He and the members of his task force are evaluating the scientific basis of possible factors (inflammation, autonomic nervous system activity, genetic profile, drug interventions [beta-blockers, alpha-agonists, statins], anesthetic depth, body temperature) on long-term outcome following anesthesia and surgery. In addition, a future issue of the Anesthesiology Clinics of North America edited by Steffen E. Meiler, MD, will be devoted to issues discussed at this conference.
Data Dictionary Task Force
The APSF Data Dictionary Task Force chaired by Terri G. Monk, MD, has been successful in creating common anesthesia terms that have been adopted by the Systematized Nomenclature of Medicine and licensed by the National Library of Medicine. Dr. Monk and her colleagues (again reflecting the cooperative efforts of industry and clinicians under the sponsorship of the APSF) have now entered the next phase of the process in developing a schema of standardized terms (minimum data elements) for use on anesthesia records as part of automated information management systems. This is the next essential step to collect comparative data, from millions of anesthetics, to determine best practices leading to improved anesthesia patient safety.
Board of Directors Workshop
The APSF Board of Directors workshop in October 2005 was organized by Jeffrey B. Cooper, PhD, APSF Executive Vice President, and reflected the foundation’s initiative to include patients in the mission of APSF. The topic of the workshop was “full disclosure” to patients when an adverse anesthesia event occurs. Participants included 3 families (a parent, a patient, a spouse) and 1 anesthesiologist who cared for the patient participant. Their poignant stories of how adverse events during anesthesia changed their lives was a moving and memorable experience for the attendees. The common message from all the participants was the compelling human need for explanations (as soon as possible) and ultimately some recognition that what happened to them or their family member would become a learning experience to reduce the likelihood of a similar experience occurring to someone else in the future.
The APSF has awarded more than $2 million dollars since 1987 for support of investigators pursuing patient safety research. Two grants for $75,000 were awarded for 2006, and 1 of these grants received an additional $5,000 as the Ellison C. Pierce, Jr., MD, Education Award. The other grant is designated the APSF/AHP Research Award in recognition of the contribution from Anesthesia Healthcare Partners for support of this grant plus an additional amount for administrative support to the APSF.
Beginning in 2007, the APSF Research Grants will be increased from the current level of $75,000 to $150,000. This increased level of funding is intended to reflect the quality of the research applications and the importance of the grant process in the mission of the APSF.
The APSF Newsletter, as the official journal of the APSF with Robert C. Morell, MD, as editor, continues to provide the most rapid dissemination of anesthesia patient safety information possible. The current circulation exceeds 76,000 recipients and reflects the fact that every anesthesia professional in the United States receives the Newsletter and benefits from the information it provides. I am personally committed to doing everything possible to insure that all anesthesia professionals continue to receive the APSF Newsletter as patient safety information is valuable and important to everyone who cares for patients in the operating room.
A highly successful part of the APSF Newsletter has been the “Dear SIRS” (Safety Information Response System) column that is coordinated by Michael A. Olympio, MD, Chair of the APSF Committee on Technology. Dr. Olympio and his committee members provide timely responses to questions including equipment design and function that are submitted by recipients of the Newsletter. These responses also include the comments from colleagues representing industry and often the manufacturers of the equipment in question.
Wall Street Journal Article
On June 21, 2005, a front page article in the Wall Street Journal entitled, “Heal Thyself—Once Seen as Risky, One Group of Doctors Changes its Ways” described the success of the anesthesia patient safety movement in reducing professional liability insurance premiums by virtue of making anesthesia safer. The article was complimentary to the APSF and its role over the years in anesthesia safety. As President of the APSF, I recognize and salute the contribution of all anesthesia professionals for their role in making possible the safety successes described in this highly visible article.
Financial support to the APSF from individuals, specialty and component societies, and corporate partners in 2005 has been most gratifying. The increased level of support in 2005 will make new initiatives possible and provide for ongoing initiatives, as well as increase research funding. In particular, the APSF wishes to recognize Anesthesia Healthcare Partners for their generous contribution in 2005 making possible the co-sponsorship with the APSF of a research grant awarded in 2006. Equally important, the October 2005 House of Delegates of the American Society of Anesthesiologists approved increasing the funding of the APSF from $400,000 annually to $500,000 beginning in 2006. Anesthesia is unique in American medicine in having a foundation dedicated to anesthesia patient safety, and this is reflected by the vision and support of the American Society of Anesthesiologists since the formation of the APSF in 1985.
As in the previous annual report, I wish to reiterate the desire of the APSF Executive Committee to provide a broad-based consensus on anesthesia patient safety issues. We welcome comments and suggestions from all those who participate in the common goal of making anesthesia a safe experience. There remains much to still accomplish, and everyone’s participation is important and valued as “your foundation” enters its 20th year.
Robert K. Stoelting, MD President, APSF