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The Anesthesia Patient Safety Foundation (APSF)
is the pioneer organization dedicated to assuring patient safety.
Formed in 1985 with the mission that "no patient shall be harmed
from anesthesia," APSF has been the leader in the proactive,
successful efforts to dramatically improve the safety of anesthesia
administration and reduce adverse events. The Executive Committee
of APSF believes that the reason for the success of its efforts
has been its attention to early identification of safety problems,
promoting research, disseminating information, and promoting an
emphasis on patient safety in clinical practice. The APSF program
has helped create a cadre of experts and a culture and infrastructure
devoted to promoting safety. We believe that these and other influences
on the profession of anesthesia, in particular the strong support
of the American Society of Anesthesiologists and other anesthesia
professional societies, have combined to produce our common goal:
maximum safety for all patients undergoing anesthesia. We stand
ready to assist others and are available for further discussion
of these issues to shape the national agenda for patient safety.
The most important feature of the APSF effort
has been the elevation of patient safety to coequal status with
more traditional concerns, such as determining the molecular mechanisms
of anesthesia, developing specialized drugs, or managing critically
ill patients. Our consistent emphasis has been on education and
research. The primary vehicle for education has been a widely distributed,
carefully crafted and readable newsletter, first distributed by
mail to every practitioner and now available on the Internet (www.apsf.org)
as well. The research has been driven by investigator initiated
ideas and has been highly leveraged. We have accomplished a great
deal with relatively few resources by fully supporting the efforts
of others and choosing a cost-effective data sharing strategy. APSF
has provided seed funding to investigators who in turn have spread
patient safety thinking throughout the academic and practicing community.
One important idea to emerge from APSF sponsored research has been
the development of realistic simulators and educational programs
for their use in training for anesthesia and other specialties.
The APSF is in general agreement with the recommendations
contained in the report of the Institute of Medicine (IOM) "To
Err is Human." We applaud the call for the establishment of
a national Center for Patient Safety and urge that the Center be
devoted to research inquiry and education only and that it not become
involved in the politics of regulating or financing health care.
We have serious concerns about the practicality, advisability and
utility of the type of mandatory reporting of serious events recommended
in the IOM report. Believing this recommendation to be premature
and too specific, we suggest instead further study of existing mandatory
systems to determine whether any form of mandatory reporting is
desirable, and if so, what form it should take. We strongly endorse
the recommendations for a voluntary reporting system and for enacting
legislation to extend peer review protection to data related to
patient safety. The two must go hand in hand.
The APSF also has serious concerns about the call
to develop methods to identify and take action against "unsafe
providers." While we agree that methods should be investigated
for assessing the performance ability and competence of health care
providers, this is not a simple matter and will require considerable
research. And, while we strongly agree that other "professional
societies should make a visible commitment to patient safety,"
we suggest that each be given more flexibility about how to address
their specific problems, rather than the very specific directives
given in the report. While APSF supports the call for implementing
practices to reduce medication errors, we caution that "proven"
methods are not easily generalized and assumptions made on those
generalizations could be counter-productive in settings other than
those in which they were tested.
APSF sees the practice of more complex surgery
and invasive procedures in physician offices as a threat to safety
because the offices are often completely unregulated. Several recent
reports support this concern. We are currently considering encouraging
the use of automated recording devices in all operating rooms similar
to the "black box," used in the aviation industry.
In health care, safety must be a never-ending
quest, particularly as efforts are made to control and reduce costs.
We believe that the lessons learned by APSF have much to offer areas
outside of anesthesia. A more detailed discussion of the APSF experience
and our position on these issues is in the attached document. We
look forward to applying our experience to the timely and necessary
discussion about assuring patient safety.
Sincerely,
Robert K. Stoelting, M.D., President
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