Circulation 60,475 • Volume 13, No. 3 • Fall 1998

New International Effort Discussed in APSF Session At July European Congress

J.S. Gravenstein, MD

“Anesthesia Patient Safety: Is it Time for an International Effort?” was the billing for a half-day meeting session sponsored by the Anesthesia Patient Safety Foundation on July 2, 1998, at the 10th European Congress of Anesthesiology in Frankfurt, Germany.

In his opening remarks, E.C. (Jeep) Pierce, Jr, the Executive Director and former charter President of the APSF, stressed that human errors, more than any other factor, are to blame for most adverse outcomes in anesthesia, wherever anesthesia is given. In the developing world, the lack of resources and the comparatively low status of anesthesiology as a discipline magnify the problem.

After the opening address, the widely diverse assembly of participants formed three groups to discuss relevant issues in anesthesia patient safety. S. Trenkler of Slovakia and Amr Montasser of Egypt led group 1 which considered the definition of patient safety. Tangible factors affecting patient safety ranged from effectiveness of sterilization and asepsis — or the lack thereof — to the availability of anesthesia equipment and the labeling of drugs. The status of anesthesiology and the relationship between surgical specialists and anesthesia providers were deemed important elements affecting the safety of anesthesia.

W. Heinrichs of Germany chaired group 2 which discussed the role of education in patient safety. Three main topics were addressed: medical school, specialty training, and continuing education. They developed several recommendations. Regarding primary medical education, anesthesia needs to gain visibility and standing in the medical school curriculum by teaching first aid and emergency medicine with information about the required drugs and methods, including the laryngeal mask airway for those not trained to intubate. Specialty training in anesthesiology varies greatly among countries, ranging from 3 to 6 years and including greater or lesser degrees of training in intensive care units. The Union Européenne Médecins Spécialistes is currently hoping to harmonize the training programs in the European Union. For continuing education, the traditional lectures and seminars can be enhanced by the use of the anesthesia simulators which are now making their appearance in many countries. The advantages of recertification of established practitioners are being discussed in several countries, and the role simulation could play in this process is under study.

Group 3, chaired by A.A. Spence from Great Britain, dealt with the question of how to organize best to support the anesthesia patient safety movement, if possible, on an international level. The leadership provided by the World Federation of Anesthesia Societies (WFSA) was emphasized and the group was grateful to Dr. Kester Brown from that organization for his trenchant comments. Indeed, the WFSA has played a prominent role with its educational missions, the publication and distribution of printed material, and the organization of large meetings all in furtherance of patient safety in anesthesia.

In the last segment of the afternoon meeting, representatives from the three groups gave summaries of their deliberations. Under the guidance of A.P. Adams from the U.K., a general discussion followed. It soon became clear that there were, on the one hand, national patient safety foundations, as exemplified by the Anesthesia Patient Safety Foundations of the United States of America and the parallel organization in Australia and, on the other hand, the global efforts of the WFSA which comprises representatives sent by numerous national anesthesia societies. Each type of organization has its strength and there is much overlap in their missions and perspectives. But there are also substantial differences. For example, the WFSA is able to send out only about 12,000 newsletters to selected representatives of its hugely populated constituency throughout the world while the APSF alone mails quarterly a much-praised newsletter to over 60,000 recipients almost all within in the United States. While the WFSA regularly conducts large international meetings and has fielded exemplary educational missions to many parts of the globe, it has supported very little research. The APSF has funded dozens of research projects, some of them now widely appreciated as having generally enhanced safety in anesthesia. One prominent feature of the APSF is its insistence that its membership reflects all those whose work has an impact on safety in anesthesia. Thus the board of directors and the Executive Committee of the APSF, in addition to the hands-on anesthesia clinicians, have representatives from insurance companies, from involved government agencies, from the different companies that supply the profession with equipment, instruments and medications, and from other medical organizations.

In the discussion of these features and in recognition of the strength of the WFSA on the one hand and that of the anesthesia patient safety organizations from various countries on the other, the hope was widely voiced that this meeting could constitute the beginning of a close collaboration toward a common goal. Exactly how to accomplish this was yet to be defined. The fact that Kester Brown from the WFSA and Jeep Pierce from the APSF spoke in favor of such a collaboration was seen by many as a promising portent. The participants at this meeting entitled “Anesthesia Patient Safety: Is it Time for an International Effort?,” left with the conviction that such an international effort was indeed not only possible but also highly desirable. All the participants looked with confidence to the leaders of the different organizations to convene a planning group to lay the groundwork for close collaboration.

Dr. Gravenstein, a former charter member of the APSF Executive Committee, is Graduate Research Professor, Emeritus, of Anesthesiology, University of Florida; University Professor Dr. W.F.List, Anaesthesiology, is from Graz, Austria.