Volume 8, No. 1 • Spring 1993

Safety Status, Future Explored by Directors

E. C. Pierce, Jr., M. D.

In October at the APSF Annual Session preceding the ASA meeting, the first retreat for the Board of Directors was held, with a total of some 50 people attending. The Directors were divided into four working groups for the Morning Session and reconvened after lunch for the Plenary Session.

The First Working Group, on Education for Safety, was directed by Drs. R. Kitz and J.S. Gravenstein and considered two aspects of education, both relating to technology: What knowledge and skills in this area should we be teaching anesthesia residents and practitioners? In addition, what technologies can be used to assist the process of education and training of anesthetists? The group recommended that the APSF broaden its view of technologies to include the anesthesia environment, identify and prioritize safety issues, develop an industry/anesthesiology forum on the subject with early direction toward resident education and the ABA/ASA Training Council, and continue support in developing anesthesia simulators.

These recommendations were considered by the APSF Executive Committee in February. It was agreed that the APSF Committee on Education will take on the task of creating a curriculum on patient safety and anesthesiology to guide the teaching and evaluation of residents and anesthesiologists. In addition, the Foundation will consider the possibility of editing a textbook on anesthesia safety, primarily directed to residents. Continued support of development for anesthesia simulators was endorsed. It was recommended that manufacturers be requested to provide more than one operations manual to hospitals when their equipment is installed so that all practitioners will have an opportunity to study the manual.

National Incident Report System Considered

The Second Working Group, on Incident Reporting and Outcome Measures, was chaired by Drs. F. Cheney and D. Gaba. The group examined types of information that could be gathered, including “incident’ reports of events in which there was a potential or actual impact on safety, prospective studies of patient outcome, and closed claim analyses. The latter, of course, is being well performed by the ASA Committee on Medical Liability and certainly should continue.

At the APSF Executive Committee meeting there was significant support for the establishment of a system to allow practitioners to report events, either confidentially or anonymously. The APSF should begin to undertake such a program, although it will require a large amount of work to design and implement. The goal of the system would be improved patient safety through direct feedback about events to the anesthesia community and not classic scientific investigation, per se. In addition, it should be noted that the ongoing experiment of asking for event reports through the APSF Newsletter has yielded some eight reports thus far. These have been written up and will be published under the column title ‘Experience is the Best Teacher.’ The Executive Committee recognized the need to strip identifiers from the reports and to discuss issues only in generic terms.

The Third Working Group, Production Pressures and Cost Containment, was chaired by Drs. R. Chilcoat and J. Cooper. It was recommended that the APSF play a role in bringing TQM concepts into anesthesia, develop programs aimed at teaching anesthetists to better manage the operating room, support programs to investigate and improve teamwork in the OR, address the issue of safety when sedation/anesthesia is administered by nonanesthetists, and enhance the involvement of anesthesia providers in hospital political processes.

The Executive Committee noted the report from the Surgical Nursing Vice President at Dr. E.C. Pierce’s Hospital, the New England Deaconess, concerning success at that hospital in bringing all parties nursing, surgery, and anesthesia together in the OR for safety and efficiency improvement. Dr. Gaba indicated that his laboratory had conducted a random survey in California concerning production pressure issues. Preliminary results from the survey were presented at the recent Society for Technology in Anesthesia meeting; these pressures are felt intensely by a significant number of practitioners. Another thought was the possible formation of a .surgical patient safety foundation’ which could work with the APSF. Dr. Pierce will discuss this with Dr. R. Hanlon of the American College of Surgeons. There is need for further research to elucidate the nature and effects of needs in OR teamwork.

The fourth working group, on Practice Parameters, was directed by Drs. D. Paulus and R. Caplan. At the retreat, the group recommended that the APSF consider sensitizing topics for practice parameters development, providing intellectual leadership and manpower for practice parameters development and possibly funding the development of practice parameters.

The APSF Executive Committee reaffirmed that the APSF plays only an ‘intellectual’ advisor role in the process of practice parameter development. The current status of the practice parameters was reviewed by the committee and potential topics for future parameters were discussed. The Executive Committee believes that the following topics should be pursued, in this order:

1. IV sedation by nonanesthetists.

2. Prevention of peripheral nerve injury.

3. Discharge criteria from the PACU.

The APSF Executive Committee will be pleased to hear other comments from APSF members, especially from Directors who attended the October Retreat. It is likely that such a retreat will be held every other year at the time of the APSF annual session.

Dr. Pierce is president of the APSF.