From the Literature: Epidemiology in Anesthesia

J.N. Lunn; Ellison C. Pierce, Jr., M.D.; G. Chapman-Clibum; R.L. Katz

Editor’s note: In each APSFNewsletter, a pertinent publication from the anesthesia patient safety literature YAII be summa6zed. suggestions for future issues are welcome.

Lunn, J.N. (ed): Epidemiology in Anesthesia. London, Baltimore and Victoria: Edward Arnold lid, 1986. Edward Arnold, 3 East Read Street, Baltimore, MD 21202; $34.50.

John Lunn, M.D. of Cardiff, has studied and written extensively about anesthesia morbidity and mortality in the UK for many years. As editor of this new book, he has collected ten chapters by thirteen international specialists applying principles of epidemiology to evaluation of anesthetic practice, including outcome, complications, occupational hazards, and developing standards. A goal of the book is to have the data used toward directing of effective planning and improving of clinical anesthesia. Some of the subjects have been examined at a scientific meeting held by the Faculty of Anaesthetists of the Royal College of Surgeons of England in 1983.

Highlights of the publication include the description of principles of epidemiology by S.C. Farrow of the University of Wales and EG.R. Fowkes of Usher Institute, Edinburgh; risk in anesthesia by H.H. Bendixen and S.M. Duberman of Columbia University; evaluation of the halothane controversy by A.A. Spence, Royal Infirmary, Edinburgh; chapters on the anesthetic record and documentation by Lunn himself and R.G.F.L. Seed, Riyadh Armed Forces Hospital; and discussions of pollution in the O.R. and development of new anesthetic drugs. In the last chapter, J.A. Bushman and J. Cushman of the Research Department of Anaesthetics at the Royal College of Surgeons look to the future in examining use of computers in anesthetic records.

AU of the chapters are good (some outstanding)

descriptions of the important areas of anesthesia epidemiology. This is all fitting, with the recent worldwide explosive interest in anesthetic patient safety, risk management, and quality assurance The book is recommended for all practicing anesthetists interested in lowering morbidity and mortality in anesthesia practices as every single one of us should well be.

Chapman-Clibum, G. (ed): Risk Management and Quality Assurance: Issues and Interactions, Special Publication. Quality Review Bulletin. Joint Commission on Accreditation of Hospitals, 875 North Michigan Avenue, Chicago, Illinois, 60611. 1986; $30.00

Katz, R.L. (ed): Safety in Anesthesia. Seminars in Anesthesia, Vol. 5, No. 3, September, 1986. Grune & Stratton, Inc., 6277 Sea Harbor Drive, Orlando, Florida 32821; $19.50.

These two additional publications should be of considerable interest to anesthetists working toward improved patient safety as the two approach the problem from different view points. Between them, they add considerably to available information for use in the United States.

Overseas readers should be aware that the Joint Commission on Accreditation of Hospitals (ICAH) is the formal accrediting body for hospitals in the United States and has recently undertaken a strong program towards risk management as well as measurement of outcome of patient care in the hospital, with the obvious objec6ve of improvement.

Contents of these publications are complimentary.

The first contains chapters on risk management in a number of areas, including anesthesia (reprinted in this Newsletter). In addition, the volume examines the professional liability crisis in the United States, the epidemiological structure of risk management, medical management analysis, relating quality assurance to credentials and privileges, and importantly, an integrated quality control program for anesthesia equipment.

The volume on Safety in Anesthesia stresses patient monitoring and specifically examines anesthesia disasters, oxygen monitoring and oximetry, capnometry and capnography, mass spectrometry, agent monitoring, future techniques in monitoring, and standards of care from a legal viewpoint.

Abstracted by Ellison C. Pierce, Jr., M.D.; Harvard Medical School and President, Anesthesia Patient Safety Foundation.