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Silker, E.S., Past Executive Director,
Anesthesia Patient Safety Foundation
Here, in the year 2001, APSF has enjoyed seventeen years of successful
activity in the cause of anesthesia patient safety. Its roots have
a basis in history and its dedication to and interest in anesthetic
morbidity and mortality has not been the private preserve of the
anesthesiologist. While England's John Snow is remembered for his
classical study [1] of chloroform deaths, the literature is replete
with the names of prominent figures in medicine who wrote about
anesthesia but were not anaesthetists. Harvey Cushing [2], then
a second year medical student, lost a patient who aspirated gastric
contents during an ether anesthetic. He later wrote that this event
almost caused him to leave medical school. His classmate, Avery
Codman, also a surgeon, fared little better. In a letter dated February
9, 1920, to Cushing, he wrote:
"There was a reason for not publishing a paper
entitled, Etherization, in which I describe the process as we then
knew it. I recall that the reason for not publishing it was because
it described in detail the case which I lost in the OR because I
was paying attention to some Tom foolery which you, who had come
in from the theatre, were entertaining us with while the poor devil
was inhaling vomitus."
Distraction, obviously, is nothing new and it seems appropriate
that the word, "vigilance", should occupy the conspicuous center
on the seal of the American Society of Anesthesiologists.
Anesthesiologists the world over have long been concerned with
and involved in studies related to anesthesia safety. Many prominent
anesthesiologists in the United States began to collect statistics
of anesthetic morbidity and mortality as early as the 1930's. Even
before our preoccupation with the issue of malpractice and its legal
implications, data were hard to come by and the various study commissions
were largely a repository of anecdotal events.
In 1983, the Royal Society of Medicine of England and the Harvard
Medical School jointly sponsored a symposium on anesthesia contributory
morbidity and mortality. Forty participants from around the English
speaking world were invited to this meeting that was held at the
Massachusetts General Hospital. The presenters discussed the morphology
and teleology of anesthetic accidents. The principal result of the
meeting was an agreement to share statistics and to define the parameters
of future studies[3].
One year later, at the 1984 meeting of the American Society of
Anesthesiologists, Dr. Ellison C.Pierce, the Society's President,
inaugurated the Anesthesia Patient Safety Foundation (APSF). The
idea for a patient-centered safety foundation was presented to,
and approved by, the ASA House of Delegates during Jeep Pierce's
year as President. Its goals were clearly stated:
"The mission of this corporation is to assure
that no patient shall be harmed by the effects of anesthesia. The
purposes of this corporation are: to foster investigations that
will provide a better understanding of preventable anesthetic injuries;
encourage programs that will reduce the number of anesthetic injuries;
and promote national and international communication of information
and ideas about the causes and prevention of anesthetic morbidity
and mortality."
A cardinal goal of APSF is to communicate and to disseminate information
about issues of anesthesia safety. The APSF Newsletter, published
quarterly, has a readership of over 60,000. In addition to anesthesiologists
and nurse anesthetists, the distribution includes the nation's risk
managers, the Board of Governors of the American College of Surgeons,
the liability insurance industry, pharmaceutical companies, medical
device manufacturers, the Joint Commission, the FDA, and, far from
least, congressional staffers responsible for health care information.
In addition to the Newsletter, APSF's website (www.apsf.org) accesses
all issues of the Newsletter information as well as information
about APSF's other activities.
Stories reported in the Newletter are far ranging. They have included
models for risk analysis, the impact of the European work station
design on anesthesia practice in the United States, controversies
such as FDA's initial attempt to limit the use of succinylcholine
in male children, sources of medical gas contamination, the FDA
approved Anesthesia Checklist, and most recently, the dangers faced
by patients who undergo anesthetics in the private offices of physicians.
The number of "letters to the editor" has increased almost exponentially
during the past five years.
A second area of uniqueness is the research grant program. Again,
the APSF goal states: "To foster investigations that will provide
a better understanding of preventable anesthetic injuries." APSF
promotes research in anesthesia safety by awarding four or five
grants of up to $65,000 per year. Each Winter Edition of the Newsletter
reports the awardees and the titles of their research projects.
Other areas of study supported by research grants have included
the effect of fatigue on resident performance, intra-operative carbon
monoxide levels, cerebral ischemia thresholds, and factors affecting
intra-operative vigilance. To date, APSF has awarded almost two
million dollars in support of such research. One of the most successful
projects begun with the help of this grant program has been the
development, and ultimate commercial availability, of anesthesia
simulators.
Other APSF projects have included recovery room safety issues,
the effects of fatigue on acuity, and joint ventures with corporate
partners that have resulted in educational brochures for: the prevention
of bacterial contamination in anesthetic agents (Zeneca); dosage
of agents and essential monitoring for the safe practice of intravenous
sedation and analgesia (Roche). APSF has also sponsored the production
of three texts: Safety and Cost Containment in Anesthesia, Capnography
in Clinical Practice and an indexed compendium of the scientific
articles which have appeared in the first eight years of the Newsletter
(Little Brown).
APSF is gratified by the recognition it has received
in the Institute of Medicine's report entitled, "To Err is Human,"
which recognizes APSF's leadership in the cause of patient safety.
Further, The Agency for Health Care Research and Quality (ARHQ)
has enlisted APSF's assistance in developing a National Center for
Patient Safety. APSF recognizes that there is still much work to
be done, and looks forward to continuing its programs on behalf
of all patients who require perioperative care.
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