In 2022, the Anesthesia Patient Safety Foundation (APSF) Board of Directors embraced “patient engagement” as an active strategic focus to further advance the foundation’s vision that “no one shall be harmed by anesthesia care.” This commitment led to the formation of a dedicated Patient Engagement Workgroup that welcomed patients as member partners in the committee and featured co-design as a key guiding principle. This collaborative approach represented a significant evolution in how the APSF approached patient safety initiatives.

Prior to this initiative, APSF had not historically developed online patient education content. To identify critical gaps that APSF might fill in this arena, the workgroup employed a multifaceted approach combining user-design principles, web analytics, and traditional review methodologies. This comprehensive analysis revealed significant opportunities to enhance patient education and engagement in anesthesia and surgical care.

UNDERSTANDING PATIENT CONCERNS

Through careful research and direct solicitation of feedback from patients, the workgroup discovered that patients consistently sought answers to fundamental questions about anesthesia and surgery, including:

• Do I need to have surgery?
• What if I have trouble waking up from anesthesia?
• How many times is it safe to go under anesthesia?
• Are there long-term side effects of anesthesia?

Notably, available online content to adequately address these concerns was scarce or incomplete. Search engine keyword research, coupled with analysis of high-ranking websites, revealed a significant opportunity to provide dedicated patient-centered resources. Meanwhile, medical journal articles, while highly detailed and up-to-date, were not patient-centered and frequently employed technical language beyond the comprehension of most patients. This clearly identified a distinct opportunity for APSF to bridge this information gap by providing content that patients truly valued—content that would enable them to take ownership of their care and effectively participate in shared decision-making with their health care providers.

THE BIRTH OF THE PATIENT GUIDE TO ANESTHESIA AND SURGERY

As a direct result of these findings, the “Patient Guide to Anesthesia and Surgery” was founded in 2022, marking APSF’s first patient-focused initiative. Developed by the APSF’s Patient Engagement Workgroup, this resource brought together patient advocates and anesthesia and surgical professionals to answer the most commonly asked questions patients have before surgery (Table 1).

Table 1: Patient Guide to Anesthesia: Content Overview.

The mission of this initiative extends beyond merely providing information—it aims to encourage patients to actively participate in their health care journey and gain a better understanding of how they can minimize perioperative risks and complications. The ultimate goal is patient empowerment, helping individuals become more involved in their care decisions and learn practical ways to mitigate their own risks.

INNOVATIVE METHODOLOGY FOR CONTENT DEVELOPMENT

The workgroup determined that the initial step in building content for the Patient Guide should embrace user-design methodology to genuinely “listen to the patients.” The primary objective was to understand their fears, concerns, and informational needs in their own terms. This approach represented a deliberate departure from typical medical articles developed for patients, which often carry a technical bias based on health care professionals’ perceptions of what information is necessary.

For the first version of the Patient Guide, the workgroup conducted comprehensive online patient surveys and in-depth interviews. The team designed survey questionnaires specifically to help understand the main fears and concerns patients harbor regarding anesthesia. Making a conscious effort to gather diverse perspectives, the surveys included participants from different age, social, and ethnic groups by utilizing the Amazon MTURK platform, an online marketplace that provides access to a demographically diverse participant pool beyond researchers’ immediate networks, thus reducing potential selection bias.

To complement the survey data, through snowball sampling, the team conducted in-person interviews to explore patients’ and their families’ concerns more deeply. These interviews employed the Empathy Map, a methodological tool used to understand user behavior, developed by Dave Gray and XPLANE¹ (Figure 1). This tool allowed us to record in different quadrants what patients see, feel, think, and do in relation to anesthesia and surgical care. It also directly explored their perceived losses and gains related to surgical procedures and anesthesia. Both the surveys and interviews provided the workgroup with a valuable list of priority topics that served as the foundation for creating the initial content for the website.

Figure 1: Empathy Map.¹ Used with permission from xplane.com.

RIGOROUS QUALITY ASSURANCE PROCESS

With the priority topics clearly defined, the workgroup designed a systematic process for content development to ensure both accuracy and accessibility. Each article followed a three-step review process:

1. Initial drafting by a workgroup member with professional expertise in anesthesia who used readability assessment tools to create content at an 11th grade reading level or lower.
2. The first review was conducted by another workgroup member without professional expertise in anesthesia to ensure readability and relevance.
3. The final review was carried out by a professional writer to standardize the texts and ensure the quality, clarity, and consistency of the information.

This multilayered approach ensured that the content maintained scientific accuracy while remaining accessible and relevant to patient needs.

MEASURING SUCCESS THROUGH ANALYTICS

Since its launch in October 2023, the Patient Guide microsite has been viewed over 82,000 times by more than 60,000 visitors, now attracting over 10,000 visits per month (Figure 2). With its broad patient audience, the Patient Guide has quickly become one of the most-visited resources on the APSF website, accounting for five of the ten most-viewed pages for the past six months.

Figure 2: Patient Guide to Anesthesia and Surgery Website Sessions.

FUTURE DIRECTIONS

Looking ahead, the Patient Engagement Workgroup has established both short-term goals and long-term strategic objectives. In the immediate future, the Workgroup plans to expand content based on analytics and user feedback, addressing additional high-priority questions identified through ongoing research.

The long-term vision focuses on more deeply integrating patient perspectives, lived experiences, and feedback into all of APSF’s initiatives. This approach recognizes that genuine patient engagement must extend beyond educational content to influence the foundation’s broader safety work, research priorities, and policy recommendations.

Opportunities for expansion include developing strategic partnerships with other patient-focused organizations and foundations to amplify reach and impact. The workgroup is also exploring multimedia formats, interactive tools, and expanded language offerings to make the content more accessible to diverse populations.

As the Patient Guide to Anesthesia and Surgery continues to evolve, APSF invites health care professionals, patients, and families to become familiar with these resources (https://www.apsf.org/patient-guide/). The “must-have” priority remains keeping patients as the cornerstone of all safety initiatives and educational materials. By maintaining this unwavering commitment to patient-centered approaches and shared decision-making as essential components rather than optional features, APSF aims to significantly advance its core vision that no one shall be harmed by anesthesia care.

Maria van Pelt, PhD, CRNA, CNE, CPPS, FAAN, FAANA, is a clinical professor at Northeastern University, Boston, MA.

Salvador Gullo Neto, MD, PhD, is an assistant professor at Pontifical Catholic University – PUCRS Porto Alegre, RS, Brazil.

Katherine Megan is a digital strategy consultant with the Anesthesia Patient Safety Foundation, Rochester, MN.

Steven J. Barker, PhD, MD, is professor emeritus of anesthesiology at the University of Arizona College of Medicine, Tucson, AZ.

Della M. Lin, MD, MS, FASA, is associate faculty at Ariadne Labs and adjunct clinical professor at John A Burns School of Medicine, Honolulu, Hawaii, HI

Della M. Lin is secretary of the Anesthesia Patient Safety Foundation. Katherine Megan is a digital strategy consultant for the Anesthesia Patient Safety Foundation. The other authors do not have any conflicts of interest.

ACKNOWLEDGMENTS

While our author team represents part of the Workgroup, we would like to express our sincere gratitude to the other members of the APSF Patient Engagement Workgroup for their valuable contributions to this initiative:

Arnoley S. Abcejo, MD; Vonda Vaden Bates; Richard P. Dutton, MD, MBA; Mike Edens; Bernadette Henrichs, PhD, CRNA, CCRN, CHSE, FAANA; Olivia Lounsbury, MS; Jay Mesrobian, MD, MBA, FASA, FACHE.

REFERENCES

1. XPLANE. The Empathy Map: A human-centered tool for understanding how your audience thinks. XPLANE website. https://xplane.com/the-empathy-map-a-human-
   centered-tool-for-understanding-how-your-audience-thinks/. Accessed February 28, 2025.