Volume 11, No. 3 • Fall 1996

Historical Perspective of APSF Shows Safety Advocacy

E.S. Siker, M.D.

Historically, interest in anesthetic morbidity and mortality has not been the private preserve of the anesthesiologist. While England’s John Snow is remembered for his classical study of chloroform deaths, the literature is replete with the names of prominent figures in medicine who wrote about anesthesia but were not anaesthetists. Harvey Cushing, then a second year medical student, lost a patient who aspirated during an ether anesthetic. He later wrote that this event almost caused him to leave medical school. His classmate, Avery Codman, also a surgeon, fared little better. In a letter dated February 9, 1920, to Cushing, he wrote:

“There was a reason for not publishing a paper entitled, Etherization, in which I describe the process as we then knew it. I recall that the reason for not publishing it was because it described in detail the case which I lost in the OR because I was paying attention to some Tom foolery which you, who had come in from the theatre, were entertaining us with while the poor devil was inhaling vomitus.”

Distraction, obviously, is nothing new and it seems appropriate that the word, “vigilance,’ should occupy the conspicuous center on the seal of the American Society of Anesthesiologists.

Anesthesiologists the world over have long been concerned with and involved in studies related to anesthesia safety. Many prominent anesthesiologists in the United States began to collect statistics of anesthetic morbidity and mortality as early as the 1930’s. Even before our preoccupation with the issue of malpractice and its legal implications, data was hard to come by and the various study commissions were largely a repository of anecdotal events.

In 1983, the Royal Society of Medicine of England and the Harvard Medical School jointly sponsored a symposium on anesthesia contributory morbidity and mortality. Forty participants from around the English-speaking world were invited to this meeting which was held at the Massachusetts General Hospital. The presenters discussed the morphology and teleology of anesthetic accidents. The principal result of the meeting was an agreement to share statistics and to define the parameters of future studies.

One year later, at the 1984 meeting of the American Society of Anesthesiologists, Dr. Ellison C. Pierce, the Society’s President, inaugurated the Anesthesia Patient Safety Foundation (APSF).

The idea for a safety foundation was presented to and approved by the ASA House of Delegates during Jeep Pierce’s year as President. Its goals were clearly stated:

“The mission of this corporation is to assure that no patient shall be harmed by the effects of anesthesia. The purposes of this corporation are: to foster investigations that will provide a better understanding of preventable anesthetic injuries; encourage programs that will reduce the number of anesthetic injuries; and promote national and international communication of information and ideas about the causes and prevention of anesthetic morbidity and mortality.”

Why a foundation when there is a viable and productive ASA Committee on Anesthesia Safety? The APSF affords the ASA an opportunity to expand its role in promoting anesthesia safety in a manner that would be difficult within the structure of an ASA committee. One of the goals of APSF, as stated above, is to communicate and to disseminate information about issues of anesthesia safety. The APSF Newsletter, published quarterly, has a readership of over 60,000. In addition to anesthesiologists and nurse anesthetists, the distribution includes the nation’s risk managers, the Board of Governors of the American College of Surgeons, the liability insurance industry, pharmaceutical companies, medical device manufacturers, the Joint Commission, the FDA, and, far from least, congressional staffers responsible for health care information. A sampling of the Newsletter articles includes models for risk analysis, the impact of the European workstation design on anesthesia practice in the United States and, controversies involving the use of succinylcholine in male children, sources of medical gas contamination and the issue of obsolesence in anesthetic equipment. The number of “letters to the editor” has increased almost exponentially during the past three years. Each Winter issue of the Newsletter reports on the four or five awardees of APSF’s annual research grants.

A second area of uniqueness is the research grant program. Again, the APSF goal states: “To foster investigations that will provide a better understanding of preventable anesthetic injuries.” The reader is referred to the Spring 1996 issue for Jeff Cooper’s comprehensive review of APSF’s grant program since its inception. To date, $ 1,288,134 has been awarded to support APSF-sponsored research projects over the past nine years. Also unique is a Board of Directors which provides a forum for the many sectors which impact anesthesia safety.

The Foundation is now in its eleventh year. It is pleased with the role it has played in advancing the cause of patient safety and grateful to the ASA, for its continuing support as the Founding Patron of APSF. We recognize that there is still much work to do and look forward to continuing the programs of APSF in behalf of all patients who require anesthesia care.

E.S. Siker, M.D. Executive Director, APSF