Circulation 81,489 • Volume 22, No. 3 • Fall 2007   Issue PDF

Safety Topics Abound at 2007 ASA

Lorri A. Lee, MD

APSF to Co-Sponsor Workshop on Teamwork

SurgeonsThe 2007 Annual Meeting of the American Society of Anesthesiologists (ASA) will be held from Saturday, October 13, through Wednesday, October 17, at the Moscone Center in San Francisco, CA. Patient safety will again be the focus of numerous refresher courses, special lectures, scientific presentations, panels, and workshops, which are highlighted below. This year the APSF is proud to co-sponsor a workshop on Teamwork and Team Training in the Operating Room (#817) to be led by Drs. David Gaba and Robert McQuillan on Monday, October 15, from 2:00-5:00 pm in the Moscone Center West (Rm 2001). This workshop will demonstrate how patient safety can be optimized when everyone in the OR works as a team (see page 53 for details). Other workshops that focus on patient safety include Healthcare Team Training in a Virtual Environment (#822A and B, Tuesday, October 16, from 8:00-9:30 am and 9:30-11:00 am, Rm 2001, Moscone Center West); Applying Human Factor Methods to Anesthesia Care (#824, Wednesday, October 17, from 8:00-11:00 am Rm 2001, Moscone Center West); and fiberoptic workshops throughout Saturday and Sunday, October 13 and 14 (Rm 130 and 132, Moscone Center North).

The 2007 Annual Meeting of the American Society of Anesthesiologists (ASA) will be held from Saturday, October 13, through Wednesday, October 17, at the Moscone Center in San Francisco, CA. Patient safety will again be the focus of numerous refresher courses, special lectures, scientific presentations, panels, and workshops, which are highlighted below. This year the APSF is proud to co-sponsor a workshop on Teamwork and Team Training in the Operating Room (#817) to be led by Drs. David Gaba and Robert McQuillan on Monday, October 15, from 2:00-5:00 pm in the Moscone Center West (Rm 2001). This workshop will demonstrate how patient safety can be optimized when everyone in the OR works as a team (see page 53 for details). Other workshops that focus on patient safety include Healthcare Team Training in a Virtual Environment (#822A and B, Tuesday, October 16, from 8:00-9:30 am and 9:30-11:00 am, Rm 2001, Moscone Center West); Applying Human Factor Methods to Anesthesia Care (#824, Wednesday, October 17, from 8:00-11:00 am Rm 2001, Moscone Center West); and fiberoptic workshops throughout Saturday and Sunday, October 13 and 14 (Rm 130 and 132, Moscone Center North).

Refresher Course Lectures Encompass Variety of Patient Safety Topics

Saturday, October 13, 2007: The 58th Annual Refresher Course Lecture Program kicks off Saturday morning with Dr. Jan Ehrenwerth discussing pitfalls of A Fire in the Operating Room! It Could Happen to You (#136, 8:30-9:20 am, Rm #3022). Following this presentation, medico-legal lectures include Dr. Christopher Spevak providing a Health Law Update for Anesthesiologists (# 126, 9:40-10:30 am, Rm 3014) and Dr. Fred Berry outlining What to Do After an Adverse Outcome (#134, 2:50-3:40pm, Rm 3018). Helpful guidelines and updates to improve patient safety and outcomes will be provided on the topics of CVP and PAC Monitoring by Dr. Jonathan Mark (#102, 9:40-10:30 am, Rm 2014), concurrent with Dr. Ronald Miller’s Update on Transfusion Medicine (#108, Rm 2018). These lectures will be followed by Controversies in Perioperative Pacemaker and Defibrillator Management by Dr. Mark Rozner (#110, 1:40-2:30 pm, Rm 2018), and in the same room, The ASA Obstructive Sleep Apnea Guidelines by Dr. John Benumof (#111, 2:50-3:40 pm). Dr. Jessica Alexander’s lecture on The Potential Hazards of Perioperative Herb and Dietary Supplement Use will provide useful information regarding our growing patient population who ascribe to complementary and alternative medicine (#118, 4:00-4:50 pm, Rm 2022).

Sunday, October 14, 2007: Sunday morning starts with a broad overview of Evidence Based Medicine in Perioperative Care—Does It Help Us Improve Care? by Dr. Brenda Fahy (#213, 8:30-9:20 am, Rm 2022), concurrent with The ASA Closed Claims Project and its Registries moderated by Dr. Karen Domino (#236, Rm 3022). Later in the day, a directed approach to Anesthesia and Patient Safety: It’s Not Only About Getting Out of the OR Alive! will be provided by Dr. Elizabeth Martinez (#210, 1:40-2:30 pm, Rm 2018). Management of common perioperative problems will be discussed by Dr. Christian Apfel in PONV: Current Thinking and New Directions (#215, 10:50-11:40 am, Rm 2022), followed in the same room by Dr. Jerrold Levy on Anaphylaxis and Adverse Drug Reactions (#216, 1:40-2:30 pm). How to protect yourself and your patient from infection will be presented by Dr. Jeanine Wiener-Kronish in her lecture Infection and the Anesthesiologists (#223, 2:50-3:40 pm, Rm 3010). Dr. James Rathmell will elucidate potential Complications in Pain Medicine and their prevention (#226, 9:40-10:30am, Rm 3014), followed by a similar presentation by Dr. Steven Roth entitled Complications in Neuroanesthesia (#221, 10:50-11:40 am, Rm 3010).

Monday, October 15, 2007: Monday morning refresher courses start with Dr. Steve Hall discussing The Child With a Difficult Airway: Recognition and Management (#326, 8:30-9:20 am, Rm 3022), concurrent with Dr. Robert Sladen’s presentation of Perioperative Care of the Patient With Renal Dysfunction (#301, Rm 2014). Dr. Lee Fleisher shares his expertise on Preop Assessment of the Patient with Cardiac Disease (#308, 1:40-2:30 pm, Rm 2018), logically followed by Dr. John Ellis’s lecture on Myocardial Ischemia and Postoperative Monitoring (#314, 2:50-3:40 pm, Rm 2022). Dr. Girish Joshi will try to clarify the hot controversy of managing The Patient with Sleep Apnea Syndrome For Ambulatory Surgery (#309, 2:50-3:40 pm, Rm 2018), concurrent with another debated topic of Depth of Anesthesia: Clinical Applications, Awareness and Beyond presented by Drs. Daniel Cole and Karen Domino (#324, Rm 3018). Dr. David Chestnut will share his vast experience and expertise to help us manage Problems in Obstetric Anesthesia: Blood Pressure, Blood Loss and Blood Patch (#315, 4:00-4:50 pm, Rm 2022). Lastly, as operating room capacity expands in many centers, and technology grows, Dr. Keith Ruskin will provide insight on Perioperative Communication Devices: Impact on Patient Safety (#325, 4:00-4:50 pm, Rm 3018).

Tuesday, October 16, 2007: Dr. Lucinda Everett starts off Tuesday’s Refresher Course lectures with a discussion of Quality and Safety Initiatives: Implications for Ambulatory Anesthesia (#401, 8:30-9:20 am, Rm 2014). Dr. Therese Horlocker will provide her expert assessment of the safety of Anticoagulation and Regional Anesthesia (#411, 8:30-9:20 am, Rm 2022), followed in the same room by Dr. Ton Gan’s knowledgeable guidance with Management of Postoperative Nausea and Vomiting (#412, 9:40-10:30 am). As Hurricane Katrina provided us with a shocking glimpse of medical emergencies during disasters, Dr. Joseph McIsaac will provide some insight into considerations for Hospital Preparation for Disasters (#413, 1:40-2:30 pm, Rm 2022). With the rapidly expanding waistlines in America, Dr. Thomas Ebert will discuss the Perioperative Considerations for the Morbidly Obese (#404, 2:50-3:40 pm, Rm 2014). Concurrent with this talk, Dr. Cliff Deutschman will review The Biologic Response to Surgery and Injury—Clinically Relevant Basic Science (#409, Rm #2018).

Wednesday, Octo
ber 17, 2007:
The ASA Refresher Courses conclude on Wednesday with Dr. Kathryn McGoldrick informing us about the largest growing segment of our population in The Graying of America: Anesthetic Implications for Geriatric Outpatients (#501, 8:30-9:20 am, Rm 2014), concurrent with Dr. James Eisenkraft’s presentation of the Hazards of the Anesthesia Workstation (#511, Rm 2022), addressing how to prevent and manage critical incidents associated with anesthesia gas delivery systems. As perioperative glucose control has become a national patient safety initiative, Dr. Daniel Brown will describe best practice for Perioperative Management of the Diabetic Patient (#513, 10:50-11:40 am, Rm 2022). Lastly, Dr. Carin Hagberg will update us on Current Concepts in the Management of the Difficult Airway (#510, 1:50-2:40 pm, Rm 2018).

Scientific Papers Highlight Patient Safety

The Scientific Papers sessions at the 2007 ASA Annual Meeting include 4 poster discussion sessions and 4 poster sessions with a focus on patient safety with 1 or more sessions each day of the meeting. Topics in these sessions include efficiency in operating room scheduling, outcomes after initiation of national patient safety initiatives, outcomes with bariatric surgery, numerous sleep apnea patient studies, the effect of mild hypothermia on intraoperative blood loss, and many others.

On Saturday, October 13, 2007, from 9:00-11:00 am (Hall D, Area G, Moscone Center North), begins the first poster presentation on the topic of Predicting Risk and Outcome from Patient Registries and Quality Databases, which includes posters on prospective perioperative adverse event databases in 2 different European hospitals (A178, Piacevolli and Barach from A.C.O. San Felippo Neri, Rome, Italy, and A179, Lehman et al. from University Hospital, Basel, Switzerland), a meta-analysis of large trials with > 5000 patients describing a reduction in perioperative mortality over time (A189, Bainbridge et al., University of Western Ontario), a presentation by Vichova and colleagues from Hospital Louis Pradel in Lyon Bron, France, on Patients with Coronary Stents and Non-Cardiac Surgery: Preliminary Results of POSTENT Study (A193), and A Meta-Analysis of the Effects of Mild Perioperative Hypothermia on Transfusion Requirement (A201) by Rajagopalan et al. from the Cleveland Clinic. In the afternoon from 1:30-3:00 pm (Rm 301 Moscone Center South), the first poster discussion session on the Public Health Impact of Anesthesiology Practice will include studies on Do Chronic Oral Opioids Impair Driving Skills? A Randomized Controlled Trial (A278, Buvanendran et al., Rush Medical College), Smoking-Induced Burn Injury While on Chronic O2 Therapy (A282, Somers-Dehaney et al., University of South Florida), and Increases in Methadone Drug Related Emergency Room Visits and Poisoning Deaths (A284, Moric et al., Rush University Medical Center).

Scientific paper sessions for Sunday, October 14, 2007 include a morning poster discussion session (9:00-10:30 am, Rm 123, Moscone Center North) on Opportunities for Patient Safety from Practice-Based Learning with studies on Delirium in the Recovery Room Is Associated with Preoperative Fasting (A501, Radtke et al., Charité-Universitäetsmedizin Berlin) and Validity of Preoperative Stress Testing in Vascular Surgery and Its Association with Gender (A502, Sun et al., Beth Israel Deaconess Medical Center). The Sunday afternoon session (2:00-4:00 pm, Hall D, Area O, Moscone Center North) will highlight Airway & Respiratory Risk; Obstructive Sleep Apnea and consists of multiple studies on screening tools for obstructive sleep apnea (OSA) syndrome as well as management of the airway for OSA/morbidly obese patients and perioperative complications in this patient group.

On Monday, October 15, 2007, one scientific paper session will take place entitled Patient Risk & Genetic Predisposition; Metabolic Interventions; Substance Abuse (9:00-10:30 am, Rm 125, Moscone Center North). The poster discussions in this session include genetic studies on 5 HT3 Antagonists and Cardiac Repolarization Time in Patients Genetically Prone to QTc Prolongation (A1029, Quraishi et al., Pennsylvania State University College of Medicine) and Novel Causative RYR1 Mutations in Malignant Hyperthermia (A1030, Girard et al., University Hospital of Basel, Switzerland), and substance abuse studies on detection of drug diversion in an operating room (A1035, Epstein et al., Jefferson Medical College).

On Tuesday, October 16, 2007, 2 patient safety-oriented scientific paper sessions are slated, starting with Drug and Device Safety, Medical Errors & Prevention (9:00-11:00 am, Hall D, Area G, Moscone Center North). This session has 3 papers dealing with MRI-related adverse events (A1596, A1599, and A1607), 2 papers on perioperative temperature control (A1611, A1612), and 3 papers on the implications of differing water content in 3 different sevoflurane formulations (A1591, A1593, and A1597). See sevoflurane article for more on this topic. The afternoon poster session on National Patient Safety Goals, Life Safety, Patient Education and Safety Culture (2:00-4:00 pm, Hall D, Area O, Moscone Center North) includes original research on patient handoffs by Joseph and co-authors (A1782, Transfer of Anesthesia Care: Are We Compromising Patient Safety?) and by Mayer et al. (A1785, Facilitating Patient Safety through an Anesthesia Resident Hand-Off of Care Training Module). Three papers deal with handwashing to prevent transmission of pathogens to patients and staff (A1786-88). Richard Cook and colleagues provide data on a novel approach to investigating medical adverse events similar to the National Transportation Safety Board investigations (A1789) so that defects in the process of care can be identified and corrected. Barach and coworkers present 2 papers on wrong-site anesthesia events (A1783) and risk factors for retained instruments and sponges after surgery (A1791).

Wednesday, October 17, 2007, marks the last patient safety scientific paper session with a poster discussion on Can We Train More and Use Information Systems to Enhance Patient Safety and Outcome? (1:30-3:00 pm, Rm 123, Moscone Center North). These 8 posters include 3 papers on increasing education about physician handwashing (A2139-41), 2 papers on using automated reminders for on-time antibiotic administration and administration of antiemetics for prophylaxis (A2142, A2144), 2 papers on using simulation to decrease anesthesia risk with the introduction of new procedures (A2138) and to practice health care team training (A2145), and 1 paper on the value of an educational lecture prior to an anesthesia machine check (A2143).

Numerous Panels Focus on Patient Safety

Numerous panels at this year’s ASA Annual Meeting focus on patient safety starting Saturday, October 13, with Dr. Michael O’Reilly and Clinical Anesthesia Decision Support: Fact or Fantasy (#PN12, 1:30-3:00 pm, Rm 307, Moscone Center South). On Sunday, October 14, Dr. William Furman will discuss Anesthesia Information Systems (AIMS) and Care Improvement (#PN20, 9:00-11:00 am, Rm 308, Moscone Center South). Later in the afternoon, Dr. Tracy Stierer will moderate a panel on Identification and Management of Patients with Obstructive Sleep Apnea (#PN24, 1:30-3:30 pm, Rm 305, Moscone Center South). Monday, October 15, Dr. Norman Cohen will participate in a panel on The Pay-For-Performance Train Has Left the Station: Now What? (#PN33, 9:00-11:00 am, Rm 307, Moscone Center South). Tuesday, October 16, Dr. Daniel Sessler will moderate a panel on Prevention of Surgical Wound Infections (#PN45, 9:00-11:00 am, Rm 305, Moscone Center South), followed in the afternoon by Dr. Gregory Crosby moderating a panel on General Anesthetic Neurotoxicity: Can It Be Bad When It’s So Good? (#PN55, 1:30-3:30 pm, Rm 308, Moscone Center South). The patient safety panels conclude on Wednesday, October 17, with Dr. Lee Fleisher moderating Strategies To Improve Perioperative Outcomes (#PN57, 9:00-11:00 am, Rm 303, Moscone Center South), followed by Dr. Dorothy Pavlin moderating a session on improving ambulatory patient safety and recovery (#PN64, 1:30-3:30 pm, Rm 303, Moscone Center South).

Rovenstine Lecture to Discuss Anesthetic Morbidity and Mortality

Dr. James Cottrell, this year’s presenter of the Emery A. Rovenstine Lecture (Monday, October 15, 11:15-12:20 pm, Rm 134, Moscone Center North), will discuss the complications and adverse effects of anesthetics in his lecture entitled “We Care, Therefore We Are: Anesthesia-Related Morbidity and Mortality.”

From the preceding list of exciting presentations, it is clear that patient safety remains in the forefront of research and clinical endeavors for anesthesiologists. We have provided only some highlights of patient safety-related lectures and presentations. Please visit the ASA website or review the meeting program for a complete list of topics and schedules.