From the Literature: Safety, Cost Strategies

J.S. Gravenstein; J.F. Holzer; Robert H. Bode, Jr., M.D.

Editor’s note: In each APSF Newsletter, a pertinent publication from the anesthesia patient safety literature will be summarized. Suggestions for future issues are welcome.

Gravenstein JS, Holzer JF: Safety and Cost Containment in Anesthesia Butterworths, Stoneham, MA, 1988.

Safety and Cost Containment in Anesthesia edited by an anesthesiologist, I.S. Gravenstein, M.D. and a risk manager who is an attorney, I.F. Holzer, provides a basic overview of the increasingly complex relationships of anesthesia patient safety, risk management, and cost-containment. The book is essentially the proceedings of a 1987 symposium at the University of Florida sponsored by the APSF and Ohmeda. It presents the viewpoints of some of the leading experts in national anesthesia risk management and includes perspectives from experts in the field of law, medicine, insurance, hospital administration, and manufacturing.

Part I of the book examines the potential risks and causes of adverse anesthesia-related incidents and injuries, a subject most anesthesiologists are aware of but unfamiliar with. Part 11 of the book expands on this theme by providing an excellent review of how anesthesia-related mishaps financially impact not only the physician, but also the manufacturer, the insurer, and the legal profession. Parts III (Improving anesthesia safety today and in the future) and IV (financial decision making with respect to anesthesia safety) of the book examine what steps need to be taken by the physician and hospital administrator to reduce anesthesia risk and optimize patient safety in an environment of increasing cost containment. Part V (Current issues) considers the pro and con side of standards in anesthesia and of automated records. Also covered is the use of simulators in training and the question of re-certification for anesthetists. The authors of the various sections review the current standards of anesthesia monitoring and provide concrete suggestions as to how anesthesiologists can eliminate risk factors that may lead to adverse events.

Safety and Cost Containment in Anesthesia provides an excellent and timely overview of a very complex subject. It is easy to re-ad, and its multidisciplinary approach to the subject is both refreshing and informative. The book is recommended to all anesthetists and administrators who are frustrated with the ever-growing complexities in the anesthesia and health care industries and want a guide to help them through the maze. In the final analysis, everyone connected with anesthesia benefits from this type of publication, especially the patient.

Abstracted by Robert H. Bode, Jr., M.D., Harvard Medical School and New England Deaconess Hospital