President Reports on State of the Foundation

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 that 2007 has been an active and rewarding year as the APSF pursues safety initiatives intended to further our mission that “no patient shall be harmed by anesthesia.” In addition to continuing safety initiatives (PCA safety, High Reliability Organization Theory, full disclosure after adverse anesthetic events) and new safety initiatives (technology training, fire safety), this past year included a greatly expanded investment by the APSF in the support of anesthesia patient safety research, both in the number of grants awarded (9 funded grants) and the total amount of the awards ($1,092,363). This critically important expansion of research support is made possible, in part, by the generous annual support ($500,000) of the American Society of Anesthesiologists (ASA) and by the full support ($150,000 each) of 3 named research awards (Cardinal Health Foundation, Anesthesia Healthcare Partners, American Society of Anesthesiologists) and the partial support of one named grant at the $100,000 level by Merck and Co., Inc.

Research

The APSF Committee on Scientific Evaluation chaired by Sorin J. Brull, MD, received 39 grant applications in 2007 for awards to begin in January 2008. In October 2007, the committee recommended funding 9 research awards, 7 at the $150,000 level. Among the named grants was the first APSF/American Society of Anesthesiologists Endowed Research Award at the $150,000 level. This APSF/ASA Endowed Research Award utilizes funds from the APSF endowment fund, which were made possible by contributions from the ASA to the APSF over the past 20 years.

The awarding of nearly $1.1 million for anesthesia patient safety research by APSF in October 2007 makes APSF the largest private funding source for anesthesia patient safety research in the world. I take extreme pride along with my colleagues in endorsing this level of patient safety research support from the APSF. Since the inception of the APSF grant program, nearly 400 grant applications have been reviewed by the APSF. When the first grants were funded in 1987, funding for anesthesia patient safety research was virtually nonexistent. Since 1987, the APSF has awarded 77 grants for a total of more than $4.5 million. The impact of these research grants is more far-reaching than the absolute number of grants and total dollars as APSF-sponsored research has led to other investigations and the development of a cadre of anesthesia patient safety investigators.

Technology Training

This issue of the APSF Newsletter contains a report of the APSF Board of Directors Workshop on “Formal Training Before Using Advanced Medical Devices in the Operating Room-Voluntary or Mandatory?” held on October 12, 2007, in San Francisco, CA. The background for this conference was the APSF’s belief that all who apply advanced medical devices, which directly affect a patient’s vital functions and immediate safety, should be certifiably trained prior to such clinical application. The manner in which such training is applied or successfully accomplished is not known, and requires deliberate investigation. For example, the most effective method of introducing a new anesthesia machine (“workstation”) into the operating room has not been thoroughly investigated, despite recent and dramatic increases in the complexity of these machines.

Although the incidence of equipment-related events is infrequent, morbidity associated with these events may be catastrophic. Human error is the leading contributor to equipment-related problems. Logic would suggest that anesthesia professionals need directed training with new and complex anesthesia equipment prior to its clinical use. The question is, “Should this training be voluntary or mandatory?” How would a patient likely respond if asked whether training before using complex anesthesia equipment in the operating room should be voluntary or mandatory?

APSF Newsletter

The APSF Newsletter continues its role as a vehicle for rapid dissemination of anesthesia safety information with Robert C. Morell, MD, as its editor. The APSF Newsletter is sent to more than 80,000 recipients including the members of the American Society of Anesthesiologists, American Association of Nurse Anesthetists, American Academy of Anesthesiologist Assistants, and the American Society of Anesthesia Technologists and Technicians.

The Spring 2007 APSF Newsletter was a special “20th anniversary celebration issue” describing past, present, and future achievements and goals of the foundation. The first APSF Newsletter was published in March 1986 with John H. Eichhorn, MD, as the editor, a position he held until 2002. Other important issues present in recent editions of the APSF Newsletter included discussions of cardiac stents and risks during the perioperative period (Spring and Summer 2007 issues), report of a conference sponsored by Cardinal Health on intensive insulin therapy (Summer 2007 issue), and descriptions of catastrophic neurologic outcomes in patients undergoing general anesthesia in the “beach chair” position (Summer 2007 issue). The Summer 2007 issue reprinted, with permission of The Doctors Company, an article by Ann S. Lofsky, MD, dealing with maternal cardiac arrests during labor and delivery. An important conclusion from this article was the observation that most cardiac arrests occurred within the first 30 minutes of the placement of the regional block. The Fall 2007 issue of the APSF Newsletter addressed the question of medication safety in an article by Drs. Stabile, Webster, and Merry entitled “Medication Administration in Anesthesia: Time for a Paradigm Shift.”

Beginning with the Summer 2007 issue of the APSF Newsletter a special section entitled “Innovative Technology and Pharmaceuticals” was introduced with the goal of providing readers with educational information regarding new developments in those areas that may directly or indirectly impact patient safety. The APSF recognizes that it is inevitable that this column will discuss products, devices, or drugs that are also sold by corporate (financial) supporters of the APSF. The APSF will zealously guard against corporate bias in these articles and strive to provide full disclosure of the author’s corporate involvement as appropriate.

The “Question and Answers” section of the APSF Newsletter is extremely popular as a resource for publication of safety questions submitted by readers and responses from members of the APSF Committee on Technology, chaired by Michael A. Olympio, MD. The “Dear SIRS” (Safety Information Response System) column in the APSF Newsletter continues to provide rapid dissemination of safety issues related to anesthesia equipment as provided by readers. This column is coordinated by Drs. Olympio and Morell.

Patient Safety Journal Section

During 2007, the APSF formalized a relationship with the International Anesthesia Research Society and their journal Anesthesia and Analgesia by creating a “Patient Safety Section” in the journal. Sorin J. Brull, MD, a member of the APSF Board of Directors and chair of the APSF Committee on Scientific Evaluation, serves as editor of this journal section.

Creation of this journal section dedicated to patient safety research provides a visible and peer-review forum for investigators working in this area of investigation.

In April 2008, the APSF will sponsor a panel at the annual congress of the International Anesthesia Research Society. The panel will address safety issues of patients with cardiac stents and anticoagulants in the perioperative period. Richard C. Prielipp, MD, chair of APSF Committee on Education and Training, will moderate the panel.

Communication

The APSF website (www.apsf.org) is coordinated by Jeffrey B. Cooper, PhD, APSF executive vice president for Strategic Planning and George A. Schapiro, APSF executive vice president for Development. All APSF Newsletters are available online. The APSF website continues to provide a monthly question for anesthesia professionals to register their opinions on patient safety topics. The monthly poll questions are developed by the APSF Committee on Education and Training.

The APSF and the ASA Committee on Patient Safety and Risk Management cosponsored a joint patient safety booth at the ASA annual meeting in San Francisco in October 2007. The booth content was developed by Drs. Joan M. Christie and Robert A. Caplan.

Data Dictionary Task Force (DDTF)/International Organization for Terminology in Anesthesia (IOTA)

Dr. Terri G. Monk, chair of the DDTF/IOTA working group, is leading the committee charged to develop terminology standards for the perioperative period. The mission of this group is to merge all the existing standards for the perioperative period and to eliminate the overlap and redundancy that presently exist in perioperative terminology. Activities of the DDTF/IOTA have been entirely supported by the APSF and the vendors of information technology systems (see the APSF website for list of vendor supporters).

The DDTF/IOTA working group continues to work on the development of a standard schema for the anesthetic record. The goal is to create a standard XML schema for the anesthetic record. This will enable anesthetic records to be exchanged between diverse information technology systems and users while ensuring semantic interoperability and traceability.

In October 2006, Dr. Monk’s group successfully obtained funding from the VA Health Services Research and Development Merit Review Board. The goals of the funded study are to analyze archived data from disparate automated information systems and develop preliminary data standards that will allow the merging of data from disparate automated information systems. Ultimately it is hoped that these data will facilitate study of the role of intraoperative variables amenable to interventions by the anesthesia professional (heart rate, blood pressure, temperature, oxygen saturation, depth of anesthesia). Currently, there is only sparse evidence to support the impact of such interventions, reflecting the fact that hand-written anesthesia records make it difficult to aggregate data on intraoperative physiology across large numbers of patients.

Financial Support

Financial support to the APSF from individuals, specialty and component societies, and corporate partners in 2007 has been most gratifying. This sustained level of financial support makes possible the undertaking of new safety initiatives, the continuation of existing safety initiatives, and increased research funding. In 2007, the APSF awarded $1,092,363 in research dollars to patient safety investigators representing more than 50% of the APSF income for the year.

Anesthesia is unique in American medicine in having a foundation dedicated to anesthesia patient safety, and this is reflected by the vision and support of the ASA since the formation of the APSF in 1985.

Concluding Thoughts

The year 2007 was saddened by the loss of Arthur S. Keats, MD. Dr. Keats was the first chair of the APSF Committee on Scientific Evaluation and guided the APSF’s early efforts in creating a “home” for investigators pursuing anesthesia patient safety research. He was a giant among his colleagues and his contributions will be a lasting memory to his skills as an anesthesiologist, teacher, and scientist.

The APSF was pleased to welcome Drs. Lorri A. Lee and Ann S. Lofsky as “consultants” to the Executive Committee during the year 2007.

As in the previous annual report, I wish to 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 experience. There still remains much to accomplish, and everyone’s participation and contributions are important.

Best wishes for a prosperous and rewarding year 2008.

Robert K. Stoelting, MD
President