President Reports on State of APSF

Robert K. Stoelting, MD

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 2004 has been a year of successes and advancement of exciting safety initiatives as APSF strives to fulfill our mission that no patient shall be harmed by anesthesia. Current patient safety initiatives include 1) audible information signals on physiologic monitors, 2) Long-term outcome following anesthesia and surgery, 3) High Reliability Organization Theory as applied to the perioperative period, and 4) automated information systems and a common terminology, which is being created by the Data Dictionary Task Force.

Audible Information Signals Monitoring the patient’s physiologic function during anesthesia is intended to facilitate, but not replace, the vigilance of the anesthesia professional. In this regard, monitors may be viewed as adding an additional “safety net” to the constant vigilance during patient care. APSF believes that use of audible alarms on physiologic monitors should be incorporated into the monitoring standards of the American Society of Anesthesiologists and the American Association of Nurse Anesthetists. In October 2004, the APSF Board of Directors sponsored a workshop on the use of “Audible Tones and Alarms” during the perioperative period. Participants included clinicians and representatives of industry. Based on the discussions at this workshop, the APSF Executive Committee supports the use of the 1) audible variable pitch pulse tone from the pulse oximeter, 2) audible low threshold alarm from the pulse oximeter, and 3) when capnography is utilized, a capnograph alarm for hypoventilation that gives an audible signal.

Long-Term Outcome The APSF sponsored an Expert Panel conference in September 2004, in Boston, MA, to discuss factors during anesthesia and surgery that might influence outcome months later. Thirty experts representing anesthesiology, surgery, cardiology, immunology, epidemiology, government, and accreditation agencies participated in the 2 days of discussions. David M. Gaba, MD, APSF secretary, served as principal investigator for the Expert Panel. The group arrived at areas of agreement that will serve as the basis for future analysis and action. These include 1) the need to reconsider the notion that the impact of anesthesia ends with the discharge from the Postanesthesia Care Unit, 2) the need for studies of large numbers of patients to better identify risk factors for adverse long-term as well as short-term outcomes, and 3) the need to better understand the role of inflammation, genetic profile of individual patients, impact of certain drugs on immune function, and anesthetic management on postoperative outcome. The APSF views the convergence of so many specialties focusing intensely on critical questions surrounding anesthesia and surgery as an important first step in better understanding patient safety factors that may ultimately influence long-term postoperative outcome.

High Reliability Organization Theory The APSF introduced this initiative with a special issue of the APSF Newsletter and a Board of Directors Workshop in October 2003. A High Reliability Organization (HRO) accomplishes its mission while avoiding catastrophic events, despite significant hazards, dynamic tasks, times constraints, and complex technologies. 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.

Automated Information Systems and Data Dictionary Task Force The goal of the Data Dictionary Task Force (DDTF) (Terri G. Monk, MD, chair), has evolved from the task of creating a standardized terminology for use in automated information systems in the United States to one of creating a standardized terminology for anesthesia in the English-speaking world. The APSF and the Systematized Nomenclature of Medicine (SNOMED) have announced a collaboration agreement to utilize the DDTF to enhance the anesthesia content currently available in SNOMED Clinical Terms. The terms will be integrated into SNOMED’s core content and will be available through the National Library of Medicine. The APSF is committed to encouraging the adoption of automated information systems as a key to providing better anesthesia care and collection of data that will contribute to best anesthesia practices and improved patient safety. The APSF believes that development of standardized clinical terminology will support documentation in the operating room, and thus improve real-time data collection and analysis to reduce anesthetic errors.

APSF Newsletter During the past year, the APSF Newsletter with Robert C. Morell, MD, as editor, has undergone a number of innovations including conversion to a four-color format. A “Safety Information Response System” column known as Dear SIRS has been enthusiastically received by both clinicians and industry. New members of the editorial board include Rodney Lester, CRNA, PhD; Lori Lee, MD; and Glenn Murphy, MD. During the past year special articles in the Newsletter included a 2-part series on “Long-Term Outcome following Anesthesia and Surgery” and discussions of postoperative visual loss. In a future issue, the Newsletter will feature a discussion of fatigue and distractions in the operating room.

American Association of Nurse Anesthetists As President of APSF, it has been my goal that all anesthesia professionals have access to the patient safety information contained in the quarterly publications of the APSF Newsletter. Beginning with this issue, the APSF Newsletter is being made available to all members of the AANA. I personally wish to acknowledge the efforts of AANA leadership, including Immediate Past President Tom McKibban, CRNA; President Frank T. Maziarski, CRNA; and Executive Director Jeffery M. Beutler, CRNA, in making it possible for this to occur. Continued Research Support Sponsorship of anesthesia patient safety-related research continues to be a high priority for the APSF. In 2004, the APSF Committee on Scientific Evaluation, Sorin J. Brull, MD, chair, reviewed a total of 31 grant applications, and 4 grants were funded for up to $65,000 each. The APSF has decided to increase the maximum grant award to $75,000 beginning in 2005. As in the past, one of the grants received an additional $5,000 as the Ellison C. Pierce, Jr., MD, Research Award recipient. Support of Future Initiatives Financial support of the APSF is key to continued successes in pursuing patient safety initiatives. Contributions from individuals, corporations, anesthesia groups, national, and state societies are critically important. The generous financial support from our founding sponsor, the American Society of Anesthesiologists, is vital for the continued ability of APSF to provide education, support research, and distribute information related to anesthesia. All donors and their level of support are recognized in the APSF Newsletter. I believe that all can be proud of the results of their continued support of APSF. As in the previous 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 experiences. There is still much to accomplish and everyone’s participation is important and valued. Best wishes for a prosperous and rewarding year 2005.

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