Patient Safety A Key ASA Meeting Theme

Patient safety continues as a featured theme of the American Society of Anesthesiology Annual Meeting. Long preceding the national focus in the recent year on "errors in medicine," safety topics have grown to become a permanent fixture of the ASA assemblage. This year’s conclave is in New Orleans from Saturday, October 13 through Wednesday, October 17.

Among the many relevant Saturday Refresher Course Lectures, Dr. T. Horlocker will present "Peripheral nerve injury following regional anesthesia: diagnosis, prognosis, and prevention" (lecture # 122). Dr. J. Eichhorn will again offer his presentation, "Risk management in anesthesia" (# 172) and Dr. F. Berry has the topic of "What to do after a bad outcome" (# 153). "The child with a difficult airway: recognition and management" (# 154) is the offering from Dr. S. Hall. Dr. D. Wedel will cover "Neurologic complications of spinal and epidural anesthesia" (#125). A major presentation will be given by Dr. R. Caplan concerning "The ASA Closed Claims Project: lessons learned" (# 175). Dr. J. Eisenkraft will again address "Problems with anesthesia gas delivery systems" (# 166) while Dr. J. Leak covers a topic new to the Refresher Courses, "The perioperative hazards of nutraceuticals (# 176).

On Sunday, the patient-safety intensive Refresher Course Lectures continue when Dr. H. Rosenberg will present an update on malignant hyperthermia (# 272). Dr. J. Benumof will lecture on "Obesity, sleep apnea, the airway, and anesthesia" (#234) while Dr. R. Stoelting will share the latest with his "’NPO’ and aspiration: new perspectives." Another major presentation will be given by Dr. S. Small entitled, "Reframing the question of human error: tools to navigate the next era in anesthesia safety" (# 226). Also, Dr. M. Warner will cover the very relevant topic of "Current thought on perioperative neuropathies and blindness."

During the Clinical Update Program sessions held mid-day Monday through Wednesday, Dr. C. Hagberg covers "Current concepts in the management of the difficult airway" (Monday # 331), Dr. M. Bishop addresses "Bronchospasm: successful management" (Tuesday # 411), Dr. J. Neal discusses "Perioperative outcome: does regional anesthesia make a difference?" (Wednesday # 531), and Dr. C. Palmer closes with "Obstetric emergencies and anesthetic management" (Wednesday # 522).

The Panel presentations at this year’s meeting offer an unusually rich array of patient-safety related topics. Monday afternoon, two panels, "Issues of concern to the aging anesthesiologist" and "Ethical challenge – the problem of incompetence" both address issues of patient safety related to performance of the anesthesia provider. Tuesday morning sees a major panel entitled "The cutting edge in patient safety" highlighting national policy issues in safety. Three of the speakers (Drs. D. Gaba, T. Monk, and J.S. Gravenstein) are members of the APSF leadership. Also Tuesday morning is a panel on "Error and injury: recognition, understanding, and intervention," one of the speakers being Dr. R. Stoelting, APSF President presenting "Pioneering efforts by anesthesiologists in the quest for patient safety." Other topics covered on that panel include "Error in American medicine: the big picture," "Communication with patients and families after an untoward event," and "The role of organizations and executive leadership in error prevention." Wednesday morning, there is a panel on "Level 1 evidence at last! Does combined epidural/GA improve outcome after major surgery?" Also Wednesday morning is a panel entitled "How to create an effective near-miss and adverse event reporting system" which will include a report from the highly successful Australian project.

In the Scientific Papers presentations, there will be four relevant sessions. In the Monday afternoon poster presentations, two papers consider epidemiologic issues of safety, "Improving anesthesia outcomes: role of national CQI data" (A-1117) and "Benchmarking perioperative anesthesia patient care events by electronic data analysis" (A-1118) while related presentation will be "A study of major adverse incident reporting systems with a focus on near-miss reporting in medical, anesthesia, aviation, nuclear power, and petrochemical industries" (A-1135). Several papers in that session will consider dangerous interactions of CO2 absorbant with volatile anesthetics. Another topic will be "Previous difficult airway: who could tell?" (A-1133).

Other epidemiology efforts are included Tuesday afternoon in "Permanent visual loss in the perioperative period: a 15-year incidence and case control study" (A-1170) and "Is there a circadian pattern of anesthetic postoperative adverse events?" (A-1181). The intriguing topic "How do solo anesthesiologists handle emergencies in remote locations?" is also in that session. "Medication problems and their relation to human error, ASA status, and patient outcomes" (A-1174) will be presented. Resource management is the focus of the paper "Crisis intervention algorithm" (A-1179) while probably the most common safety issue of all is covered in "Ulnar nerve dysfunction induced by pressure or flexion" (A-1182). Other topics addressed include meningitis after spinal anesthesia (A-1186), how the decision to extubate upon emergence is made (A-1187), preventability of pulmonary aspiration (A-1193), and the impact of night-time work on residents’ performance (A-1196).

These previews highlight only some of the extensive and widely varied safety-related presentations at this year’s ASA meeting and a full schedule can be found in the Annual Meeting Program.