By Robert F. Early, Jr., M.D.
Anesthesiologists – or the physicians responsible for relieving pain and rendering patients unconscious for surgery as well as managing the medical care of patients before, during and after surgery – have been at the forefront of patient safety during the last century. Below is information that highlights some of those efforts.
American Society of Anesthesiologists (ASA)
Founded in 1905, organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient. The organization functions as a research, scientific and educational resource for anesthesiologists, patients, the public and policymakers; it also provides highly respected guidance and expertise, particularly in patient safety matters.
Vigilance – safety requires that all anesthesia providers exercise vigilance when caring for every single patient.
A commitment to Improving Patient safety
Few professional societies or groups have demonstrated a visible commitment to reducing errors in health care and improving patient safety, with one exception: anesthesiologists (from a 1999 report by the Institute of Medicine).
During the past 30 years, patient deaths due to anesthesia have declined from one for every 10,000 cases to one per 200,000 to 300,000 cases.
Patient Safety Highlights
In the late 1970s, anesthesiologists began an effort to improve anesthetic mortality rates by determining the cause of adverse anesthesia-related outcomes and focusing attention on avoiding these causes. Lawsuits were frequent and premiums paid for malpractice insurance were among the highest for anesthesiologists. While fiercely fighting for laws that would protect physicians against frivolous lawsuits (tort reform), anesthesiologists also concentrated with patient safety with the goal that less harm to patients would mean fewer lawsuits. Indeed, anesthesia malpractice insurance premiums have decreased steadily during the last 20 years.
In 1985, with the financial assistance of American Society of Anesthesiologists (ASA), the Anesthesia Patient Safety Foundation (APSF) was formed with the mission that “no patient shall be harmed from anesthesia.” APSF is a pioneer, stand-alone organization solely devoted to patient safety with the dramatic success of its efforts based on attention to early identification of safety problems, supporting and encouraging research, disseminating information, and promoting an emphasis on patient safety in clinical practice. The foundation includes in its membership not only physicians but nurses, insurers, lawyers, regulators and representatives from the manufacturing and pharmaceutical industries. A newsletter is published quarterly and the activities of the foundation can be obtained through the website.
In 1986, ASA was the first medical specialty to adopt standards of care for its members. Today, more than 40 standards, guidelines and statements developed by the society provide guidance to improve decision-making for anesthesiologists and promote beneficial outcomes for our patients.
Since 1985, ASA has conducted a detailed analysis of closed anesthesia claims (ASA Closed Claims Project). Very little was known about people injured or killed during anesthesia prior to 1985.
No United States database existed, so ASA began collecting this information to create an overall picture of how anesthesia accidents tend to occur. In a short time, an alarming trend showed 40 percent of deaths from anesthesia were related to ventilation (breathing) failures.
This research contributed to two innovations that between them have dramatically decreased or virtually eliminated death and injury from ventilation failure. One, pulse oximetry, noninvasively measures the oxygen level in the patient’s blood, and the other, capnography, measures carbon dioxide in a patient’s exhaled breath. Also, anesthesia machines have been redesigned to be much safer and anesthesia drugs are much improved as compared to 20 years ago.
The Closed Claims Project continues to be active by examining adverse patient outcomes and identifying recurring patterns of injuries, which assist clinicians to more safely care for patients.
In health care, safety must be a never-ending quest, particularly as efforts are made to control and reduce costs. Anesthesiologists will continue to work tirelessly to assure our patients remain safe under our care.