President Reports on State of APSF

Robert K. Stoelting, MD

2003 Replete With APSF Successes

As President of the Anesthesia Patient Safety Foundation (APSF), it is my privilege to report annually on the activities of the foundation during the past calendar year. I am pleased to report that 2003 has been a year of successes and achievements as the APSF strives to fulfill our mission that no patient shall be harmed by anesthesia.

Administrative Reorganization

Ellison C. Pierce, Jr., MD, retired as Executive Director on December 31, 2003. Dr. Pierce was the moving force and vision for the formation of the APSF in 1985, serving as the first president of APSF, and since 1997, as the Executive Director. His contributions and accomplishments to anesthesia patient safety were recognized by special presentations during the annual meeting of the APSF Board of Directors in San Francisco this past October. Anesthesia is a safer experience because of the tireless efforts of Dr. Pierce. His colleagues and patients thank him. We extend to Jeep and his family our best wishes for a pleasant and rewarding retirement.

The transition for moving the APSF office to Indianapolis from Boston and Pittsburgh began in July 2003. Deanna Walker began her new duties as Administrative Assistant for APSF in the Indianapolis office in July 2003. Contact information for the Indianapolis office is detailed in the APSF Newsletter and on the APSF Website.

Executive Vice Presidents

The APSF Board of Directors approved changes to the Bylaws at the annual meeting in October 2003 that included the provision for more than one Executive Vice President position. In view of the consolidation of the office of President and Executive Director into a single position, it was recognized that program development and corporate development would benefit from the efforts of a dedicated officer position. In this regard, Dr. Jeffrey B. Cooper and Mr. George A. Schapiro were elected to the offices of Executive Vice President by the APSF Board of Directors in October 2003. All other offices, including the office of Vice President, remain unchanged.

Data Dictionary Task Force

The Data Dictionary Task Force (DDTF) chaired by Terri G. Monk, MD, from the University of Florida has succeeded in accomplishing the “impossible” by creating the beginnings of a set of common anesthesia terms for use with anesthesia information systems (AIMS). The APSF DDTF is an international effort with collaboration from the American Society of Anesthesiologists and its Committee on Performance and outcomes Measurement, the Canadian Anesthesiologists’ Society, and the National Health Service Information Authority in the United Kingdom. In October 2003, the APSF and the Systematized Nomenclature of Medicine (SNOMED) International Organization announced a 5-year collaboration agreement to utilize the DDTF to enhance the anesthesia content currently available in SNOMED Clinical Terms. The new concepts will be integrated into the SNOMED CT Core content and be available through the National Library of Medicine’s Unified Medical Language System (UMLS).

The success of the DDTF was greatly enhanced by the efforts of Dr. Iain C. Sanderson from Duke University who chaired the DDTF Working Group. Dr. Sanderson developed the software for Distributed Anesthesia Terms and Mapping System (DATAMS) that permits cross-compatibility of terms used by manufacturers of AIMS. Global corporate sponsors of the DDTF include a number of the AIMS suppliers, GE Medical Systems, Deio, Philips Medical Systems, Siemens Medical Systems, Draeger Medical, eko systems, Picis, Inc., and Cerner Corporation.

The APSF is committed to encouraging the adoption of AIMS as a key to providing better anesthesia care, collection of data that will contribute to development of best anesthesia practices, and improved anesthesia patient safety. The APSF believes that the development of standardized clinical terminology will support documentation in the operating room, and thus improve data collection and analysis to reduce anesthetic errors.

American Association of Nurse Anesthetists I am pleased that a continuing dialogue has been established with the American Association of Nurse Anesthetists (AANA) and the APSF Executive Committee to discuss common areas of interest in anesthesia patient safety. In an effort to ensure communication and sharing of anesthesia patient safety information, selected articles from the APSF Newsletter may be reprinted in the AANA NewsBulletin. The APSF Newsletter editorial board includes Rodney C. Lester, PhD, CRNA, and encourages patient safety articles from all those who participate in anesthesia care.

High Reliability Perioperative Medicine

The APSF introduced its initiative on High Reliability Perioperative Medicine with a special Spring 2003 issue of the APSF Newsletter devoted to High Reliability Organization (HRO) theory and a workshop at the annual meeting of the American Society of Anesthesiologists in October 2003. The workshop was moderated by Drs. David M. Gaba and Jeffrey B. Cooper. As evidence of the multidisciplinary role of all those who participate in perioperative care, the APSF was pleased to include Dr. James E. Cottrell, President of the American Society of Anesthesiologists, Dr. Thomas R. Russell, Executive Director of the American College of Surgeons, and Thomas A. Cooper, Executive Director of the Association of Perioperative Registered Nurses in the workshop program.

A HRO repeatedly accomplishes its mission while avoiding catastrophic events, despite significant hazards, dynamic tasks, time constraints, and complex technologies. Examples include civilian and military aviation. Many of the features that characterize an HRO are applicable to the operating room environment and perioperative care. The APSF believes that anesthesia patient safety may be improved by applying HRO concepts and strategies to the practice of anesthesiology.

Newsletter

The APSF Newsletter under the leadership of Robert C. Morell, MD, and an outstanding Editorial Board continues to provide timely and worldwide distribution of vitally important anesthesia patient safety information. Beginning with the Spring 2003 issue, the APSF Newsletter was designated the Official Journal of the Anesthesia Patient Safety Foundation. During the past year the Newsletter has included articles on “smart pump technology” and its relationship to error reduction, continued discussion on perioperative beta blockade, obstructive sleep apnea, postoperative visual loss, and SARS. The Fall 2003 issue of the Newsletter was a special issue addressing long-term outcome and the role of anesthetic management and mediators of inflammation.

Continued Research Support

Sponsorship of anesthesia patient safety-related research continues to be a high priority for APSF. In October 2003, the APSF Committee on Scientific Evaluation, chaired by Sorin J. Brull, MD, awarded 3 research grants with funding up to $65,000. One of these grants received an additional $5,000 as the Ellison C. Pierce, Jr., MD, Research Award recipient (see Grant Awards, page 50).

An APSF 2002 Grant Applicant Survey conducted by Dr. Karen L. Posner described a total of 272 grant applications received by the APSF between 1987 and 2001. A total of 33 projects have been funded during that time period, and nearly 90% of the funded studies resulted in publications. In the early years, the APSF was the only funding source for patient safety research, and this was important in initial support of investigators pursuing development of simulators for anesthesia, human factors research, and device development. Many of those investigators receiving APSF grants have gone on to develop highly successful academic careers with multiple peer review publications often in the area of anesthesia patient safety.

Special Recognition

David M. Gaba, MD, APSF Secretary, received the 2003 Society for Education in Anesthesia-Duke Award for Excellence and Innovation in Anesthesia Education at that society’s annual meeting in San Francisco in October. Dr. Jeffrey B. Cooper, member of the APSF Executive Committee and Board of Directors, received the 2003 AANA Public Interest in Anesthesia Award as well as the 2003 Eisenberg Award for Lifetime Achievement (see Cooper Award, page 51). Robert K. Stoelting, MD, President APSF, received the 2003 American Society of Anesthesiologists Distinguished Service Award (see next page).

Contributions from individuals, corporations, anesthesia groups, and national and state societies are critical for the APSF to continue and advance its patient safety mission. The generous financial support from our founding sponsor, the American Society of Anesthesiologists, is vital for the continued ability of APSF to provide education, research, and information related to anesthesia patient safety to everyone. All donors and their level of support are recognized in the APSF Newsletter. In particular, the support of AstraZeneca in the form of a grant for defraying the costs of the APSF Newsletter is greatly appreciated. I believe that all can be proud of the results of their continued support of APSF.

As in the last annual report, I wish to again reiterate the desire of the APSF Executive Committee to provide a broad-based consensus on anesthesia patient safety issues. We welcome comments and suggestions from all those who participate in the common goal of making anesthesia a safe medical experience. There is still much to accomplish and everyone’s participation is important and valued.

Best wishes for a prosperous and rewarding year 2004.

Robert K. Stoelting, MD President, Anesthesia Patient Safety Foundation