Circulation 60,475 • Volume 13, No. 4 • Winter 1998

The State of the APSF Annual Message

Robert K. Stoelting, M.D.

The year 1998 represented my first year as President of the Anesthesia Patient Safety Foundation (APSF) and the first time since the formation of the APSF that this “annual state of the APSF” editorial has been written by other than the APSF’s founder, Ellison C. “Jeep” Pierce, Jr., M.D. Dr. Pierce continues as the foundation’s Executive Director, providing daily direction and support for the ongoing activities of the APSF.

I am pleased to report that 1998 has been a busy and successful year for the APSF as we strive to fulfill our mission that every patient experience optimal anesthesia safety during the perioperative period. Perhaps the most visible activity of the APSF is the quarterly publication of the APSF Newsletter under the able direction of its Editor, John H. Eichhorn, M.D., and his Editorial Board. With a worldwide circulation of more than 60,000 the Newsletter serves a vital role in disseminating anesthesia safety information. Articles published during the last year have discussed a variety of topics including the safety of spinal anesthesia performed with lidocaine-containing solutions and the increased incidence of ischemic optic neuropathy, especially in patients undergoing prolonged orthopaedic operations. Current Newsletter issues can be viewed on the APSF Web page ( and past issues are available on CD-ROM. The CD-ROM and a book entitled, “Anesthesia Patient Safety, A Modern History: Selections from the APSF NEWSLETTER” are available for purchase from the APSF Pittsburgh office.

Sponsorship of patient safety related research has always been a high priority for the APSF. In October 1998, the APSF Committee on Scientific Evaluation, chaired by Jeffrey B. Cooper, Ph.D. awarded two research grants: 1. Karen B. Domino, M.D. (University of Washington School of Medicine) to study “Outcomes of Anesthesia and Surgery in Rural Hospitals: Factors Associated with Mortality, Complications and Failure to Rescue,” and 2. Terri G. Monk, M.D. (University of Florida College of Medicine) to perform a “Prospective Study Evaluating the Relationship between Age and PostOperative Cognitive Dysfunction Following General Anesthesia.”

On February 17, 1998, The Executive Committee of APSF wrote to the Health Care Financing Administration (HCFA) to express its opposition to HCFA’s proposed rule to eliminate mandatory physician supervision of nurse anesthetists. It was the position of the members of the Executive Committee of the APSF that the burden of proof rested with HCFA to provide definitive evidence that any change in existing supervision requirements was safe. This letter was criticized by some certified registered nurse anesthetists (CRNAs) who felt that the APSF had taken a political stand. I disagree and again emphasize the Executive Committee’s action was based on a belief that patient safety was the only consideration. In this regard, however, I wish to emphasize my desire, as well as that of the Executive Committee of the APSF, to continue to seek participation in the activities of the APSF by all those who participate in delivery of anesthesia, including CRNAs.

Contributions from individuals, corporations, national and state societies are vital for the APSF to continue to sustain its mission. I am pleased that William D. Owens, Immediate Past President of the American Society of Anesthesiologists (ASA) in his “Annual Report” to the 1998 House of Delegates urged that the ASA’s financial support for the APSF and the other foundations be sustained. The 1999 ASA President, John B. Neeld. M.D., also voiced his support for continued financial support. During the past 12 months, a special effort has been made to increase financial support from state anesthesia societies, anesthesia specialty organizations, and anesthesia practice groups with gratifying results. A new category of “Community Donors” has been established to recognize these contributors and is published along with “Corporate Donors” in each issue of the Newsletter.

In an effort to determine “the most important current issues in anesthesia patient safety” the Executive Committee of the APSF developed a survey that was mailed in September 1998 to more than 1600 anesthesiologists using a mailing list provided by the ASA. It was not possible to obtain a similar mailing list from the American Association of Nurse Anesthetists and, therefore, CRNAs did not receive the survey. The results of this survey will be published in a future APSF Newsletter and will help establish priorities for future educational and research activities. The survey results will also be available on the APSF web site.

The APSF Executive Committee, in its efforts to provide a broadbased consensus in anesthesia patient safety, welcomes comments and suggestions from all those who participate in anesthesia care and/or are concerned with patient safety. We have accomplished a great deal but this should serve only as the foundation for future successes.

Robert K. Stoelting, M.D. President Anesthesia Patient Safety Foundation