In 1985 the Anesthesia Patient Safety Foundation was organized, with me as President, a 20-erson Board of Directors, and seven members of the Executive Committee. I served as President until October 1997, when I was succeeded by Robert K. Stoelting, M.D., Chairman of the Department of Anesthesia, Indiana University, and immediate past Scientific Vice President of the American Society of Anesthesiologists. The original budget was about $150,000, including contributions from industry and individual ASA members. Now the budget is some $600,000, about 25% of that goes into research grants in the area of patient safety and $200,000 going into the Endowment. The annual ASA contribution of $400,000 is scheduled to cease at the end of the year 2000.

In the beginning, most estimates of anesthesia mortality in this country ran about one death per 10,000 anesthetics; today we do not know the rate but many place it at one per 200,000 or better. This figure is certainly suggested by the very large reduction in anesthesia liability insurance relativity and premiums. If the savings for each anesthesiologist is $25,000 per annum (a reasonable guess), the total savings for this country would be in the neighborhood of 300 million dollars per year.

However, in this era of cost containment and bottom line decision-making by HMOs, we run the real risk of sliding backwards in patient safety. J.S. Gravenstein, M.D. professor at the University of Florida and member of the original APSF Board, has stated the problem succinctly: “We must raise our voices in support of safety. If we do not, safety will take a back seat to economy.”¹

In working with residents and newer members of our department, I realized how little many of them knew about the changes in anesthesia that produced the improvement in mortality rates over the last decade and a half. I urge interested individuals to read two sources of this remarkable history. The first is an APSF softcover book, Anesthesia patient Safety, A Modern History: Selections from the APSF Newsletter, available from the APSF office.² The other is my 1995 Rovenstine Lecture, “40 years Behind the Mask: Patient Safety Revisited.”³

I certainly hope that the future of safety in anesthetic practice is as exciting as the past. Go for it!

Ellison C. Pierce, Jr., M.D. APSF Executive Director

References

1. Gravenstein, JS: Will “Cost containment” decrease safety? Anesthesia Patient Safety Foundation Newsletter 1995;10:25-9.
2. Eichhorn, JH, Ed: Anesthesia Patient Safety, A Modern History: Selections from the PSF Newsletter. 1997.
3. Pierce, EC, Jr.: the 34^th Rovenstine Lecture, “40 Years Behind the Mask: Patient Safety Revisited.” Anesthesiology, V84, no. 4, Apr 1996.