Circulation 34,475 • Volume 16, No. 1 • Spring 2001

Special Issue: Production Pressure – Does the Pressure to Do More, Faster, with Less, Endanger Patients? Potential Risks to Patient Safety Examined by APSF Panel

Robert C. Morell, MD; Richard C. Prielipp, MD

Potential Risks to Patient Safety Examined by APSF Panel

Related Article:

Production Pressure and Anesthesia Professionals


In November 1999 and March 2001, reports from the Institute of Medicine (IOM) heightened the public’s consciousness regarding the safety of hospitalized patients. As anesthesiologists we are recognized as leaders in efforts to insure patient safety throughout the medical care process. This special edition of the APSF Newsletter follows on that theme, as we asked an elite panel of experts to address the question: “Do you perceive an erosion of patient safety during the last decade?” Recent newspaper headlines, such as those noting the 90-day moratorium on office-based surgery (requiring general or spinal anesthesia) by the Florida Medical Board suggest the answer may be “yes.” Naturally, we have tried to cite data, where available, but sometimes there are no relevant data to prove or disprove a hypothesis. For instance, it is hard to find or document the effects of operating room staffing ratios on patient safety. Yet we all know that quality and safety are inseparable. Who would fly on a commercial airliner which advertised cheaper fares because the co-pilot had been eliminated from the cockpit, despite the “rationale” that no data show a solo pilot decreases safety? Sometimes, we must listen to, and apply, the opinion of experts without waiting for proof that their experience, feelings, insights, and testimony have corroborating evidence from scientific trials (if that were even possible).

Thus, we offer no apology if readers feel we have failed to “prove” the hypothesis that patient safety has been eroding. Rather than looking for a statistical test with P²0.05, we encourage the anesthesia provider to stop, read, listen, and reflect on these reports. Examine your own situation. Does this apply in your hospital? Your office setting? Your ICU? What would it mean if we answered with a collective “yes” to these questions? And, if you still remain skeptical, then remember, too, that you cannot “prove” that dragons do not exist. Please read on. We look forward to your comments.


Dr. Morell (Associate Editor, APSF Newsletter) is Director, Preoperative Assessment Clinic.

Dr. Prielipp (Chairman, APSF Committee on Education and Training) is Professor and Section Head, Critical Care Medicine, both at Wake Forest University School of Medicine, Winston-Salem, North Carolina.