The APSF Revisits Its Top 10 Patient Safety Priorities

Steven Greenberg, MD, FCCP, FCCM

In 2018 the APSF Board of Directors (BOD) voted on its top perioperative patient safety priorities. This list was generated from a combination of a review of the most current literature, submissions to the APSF Newsletter, and expert opinions from the multiprofessional representatives of the BOD. Since then, the APSF has devoted its resources to enhancing education, research, and awareness with regards to these priorities (https://www.apsf.org/article/improving-perioperative-patient-safety-a-matter-of-priorities-collaboration-and-advocacy/). The current BOD has felt the need to revisit the top patient safety priorities on an annual basis to accurately represent the most current perioperative patient safety issues.

Current APSF Vice President Dan Cole, MD, led a task force to generate a survey that was distributed to all APSF BOD and committee members. The poll responses were then tallied by the task force generated from the BOD. From a list of the top 16 priorities, the BOD voted on selection of the Top 10 Patient Safety Priorities for 2021 (figure 1). Past, present, and future activities focusing on these patient safety priorities are also listed in figure 1. A culture of safety, inclusion, and diversity ranked number one, while teamwork, collegial communication, and multidisciplinary collaboration, and preventing, detecting, determining pathogenesis, and mitigating clinical deterioration in the perioperative period were ranked two and three, respectively.

Figure 1: APSF’s 2021 Perioperative Patient Safety Priorities and Ongoing Activities

The following list contains our top 10 priorities and notes the activities for each that we have done in the past 5 years.
The summary of activities is not exhaustive.

1. Culture of safety, inclusion, and diversity

  • APSF addressed this issue in its 2017 ASA Annual Meeting workshop, as well as in APSF Newsletter articles and presentations
  • The 2019 Pierce Lecture by Jeff Cooper, PhD, highlighted this issue; his remarks were published in February 2020 APSF Newsletter
  • APSF has supported 1 research grant on this issue in the past 5 years

2. Teamwork, collegial communication, and multidisciplinary collaboration

  • APSF serves as the collaborating organization and supporter of the Multicenter Handoff Collaborative (https://www.apsf.org/article/multicenter-handoff-collaborative/)
  • This was the topic of the 2017 APSF Stoelting Conference and several APSF Newsletter articles
  • APSF provides financial and infrastructure support to the Multicenter Handoff Collaborative

3. Preventing, detecting, determining pathogenesis, and mitigating clinical deterioration in the perioperative period

    1. Early warning systems in all perioperative patients
    2. Monitoring for patient deterioration
      1. Postoperative continuous monitoring on the hospital floor
      2. Opioid-induced ventilatory impairment and monitoring
      3. Early sepsis
    3. Early recognition and response to decompensating patient
  • The 2019 Stoelting Conference was dedicated to this topic
  • This topic has been highlighted in 2020 APSF Newsletter issues and APSF-sponsored panels and presentations
  • APSF is collaborating with American Society of Anesthesiologists (ASA) and other subspecialty organizations to address specific issues related to this topic
  • APSF will support prototype development for several models that may reduce failure-to-rescue
  • APSF has supported 2 research grants on this issue in the past 5 years

4. Safety in non-operating room locations such as endoscopy, cardiac catheterization, and interventional radiology suites

  • APSF has addressed aspects of this issue recently in APSF Newsletter articles (e.g., June 2020)
  • APSF has supported 3 research grants on this issue in the past 5 years

5. Perioperative delirium, cognitive dysfunction, and brain health

  • The APSF supports this ASA-American Association of Retired Persons initiative.
  • This issue is addressed in the October 2020 APSF Newsletter.
  • APSF has supported 3 research grants on this issue in the past 5 years

6. Prevention and mitigation of opioid-related harm in surgical patients

  • This issue has been addressed in 11 articles in the APSF Newsletter since 2016
  • APSF has supported 1 research grant on this issue in the past 5 years
  • APSF supports ongoing efforts in the U.S. Congress, Joint Commission, and regulatory agencies to promote postoperative monitoring of patients who have received opioids

7. Medication safety

    1. Drug effects
    2. Labeling issues
    3. Shortages
    4. Technology issues (e.g., barcoding, RFID)
    5. Processes for avoiding and detecting errors
  • The 2018 Stoelting Conference was dedicated to this topic
  • APSF presented panels at the 2019 ASA and New York State Society of Anesthesiologists’ annual meetings
  • Multiple APSF Newsletter articles have been published on this issue in 2020
  • APSF will co-host a summit in 2021 with the Institute for Safe Medication Practices

8. Emerging infectious diseases (including but not limited to COVID-19), including patient management, guideline development, equipment modification, and determination of operative risk

9. Clinician safety: Occupational health and wellness

  • This will be the topic of the 2021 APSF Stoelting Conference
  • Five articles on this issue have been published in the APSF Newsletter
  • APSF has supported 1 research grant on this issue since 2016

10. Airway management difficulties, skills, and equipment

  • Several APSF articles have addressed this issue in recent APSF Newsletter articles
  • APSF has supported 3 research grants on this issue in the past 5 years

New additions to the current patient safety priority list include (2) teamwork, collegial communication and multidisciplinary communication; (6) prevention, and mitigation of opioid-related harm in surgical patients; (8) emerging infectious diseases (including, but not limited to COVID-19), including patient management, guideline development, equipment modification, and determination of operative risk; and (9) clinician safety, occupational health, and wellness.

The priority of creating a culture of safety was elevated to the top priority in 2021 and was modified to encompass the importance of inclusion and diversity in perioperative patient safety. All of these topics represent the current world we live in with respect to perioperative patient safety and are in line with the APSF’s vision “that no one shall be harmed by anesthesia care.”

Some topics that were ranked at the lower end of our priority list in 2018 did not remain on the top 10 priority list in 2021: (9) cost-effective protocols and monitoring that have a positive impact on safety; (10) integration of safety into process implementation and continuous improvement; (11) burnout; and (12) distractions in procedural areas. Some of these topics will be integrated into the new 2021 patient safety priorities and others did not gain traction for ranking when compared to the current ones.

The APSF is creating advisory groups whose goals are to develop recommendations on how to best allocate APSF resources to the 2021 Top 10 Patient Safety Priorities. These groups will also act as experts on the specific priorities so that the APSF can provide the most novel approaches to improving patient safety on these important issues to its worldwide constituency. Please join the APSF in making the necessary changes in your own practices as it relates to patient safety priorities and beyond.

 

Steven Greenberg, MD, is secretary of the APSF and editor of the APSF Newsletter. He is also clinical professor in the Department of Anesthesia and Critical Care at the University of Chicago and vice chairperson, Education in the Department of Anesthesiology, Critical Care and Pain Medicine at NorthShore University HealthSystem.


The author has no conflicts of interest.