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What does APSF do and what have
been the roots of its success? APSF is a multidisciplinary 501(c)
3 corporation. Our Board of Directors includes representation from
medicine, nursing, law, health care administration, and biomedical
engineering as well as from the insurance, pharmaceutical, and medical
technology/equipment industries. The concise mission statement of
the APSF: "That no patient shall be harmed by anesthesia"
should be extended to all of the areas of effort outlined in the
IOM report. The philosophy of the APSF, which resonates throughout
the IOM report, is that patient safety is a problem that should
be treated in much the same way medicine approaches diagnosis, assessment
and action. Suffering from disease or from medical error can be
reduced by gathering data, conducting research, crafting and implementing
interventions, as well as providing education to health care personnel
and to patients and their families. These efforts will require involvement
by Federal, State and local governments, by health care organizations,
by professional societies and private foundations, and by the public.
There is every reason to adopt missions and philosophies analogous
to those of the APSF for the entire effort to promote safety throughout
the health care system.
Education and dissemination about clinical problems and best practice
solutions: In support of the APSF mission, we have focused our efforts
on education and research. We believe that the single most important
impact of all that we do is to elevate discussion about patient
safety to coequal status with more traditional concerns in the field.
We did not have to regulate or set standards. We let others in their
traditional roles do that. What we did so successfully was to motivate
and support research and to offer information and a forum for debate
about safety. We did this as a collaborative among the key stakeholders.
We did it by being relentless in our message. We did not try to
tell practitioners exactly what to do or how to do it. Rather, we
motivated discussion via the APSF Newsletter, which is disseminated
without charge to every anesthesia practitioner (both physicians
and nurse anesthetists) in the U.S. and Canada (over 60,000 circulation
- see the APSF Web site, (www.apsf.org), for current and past issues
of the newsletter). We believe this vehicle has been very effective
in illustrating the safety message. It has motivated changes in
practices, in behaviors, and most importantly, in practice cultures
that have been responsible cumulatively for a reduction in adverse
outcomes.
The topics covered in our newsletter have been chosen with careful
deliberation about what to present to practicing clinicians. We
have had many successes and a few failures in our objective to engage
our colleagues in safety discussions, generating interest and synergy
while avoiding conflicts that would be destructive. By carefully
defining our audience and crafting the safety message, we have created
a highly respected and very widely read publication. To those who
are looking to do this in other arenas, we can offer consultation
and guidance concerning elements that generated positive action.
Similarly, the APSF research program has been highly leveraged.
Since 1987, two to five research awards have been made each year.
The current maximum award is $65,000 per grant with no more than
three grants annually. A total of over $1.7 million has been spent
on 45 projects. Reviews of the grant program have been published
in the APSF Newsletter in 1994 and 1998 and can also be found at
the APSF Web site.
The research program has been operated primarily by volunteers
and its administrative expenses are approximately 2% of the funds
awarded. Yet, the result appears to have been highly effective.
Once there was essentially little to no explicit discussion of patient
safety at the annual meeting of the American Society of Anesthesiologists.
Now, there are 50-100 abstracts presented in special sessions. There
are more than 20 grant applications received by the APSF each year
from investigators representing a wide spectrum of academic training
programs, as well as other types of institutions. Those who were
not funded by the Foundation have often identified other sources
of funding for their important work. In this way the research program
has created a thoughtful cadre of investigators and local leaders
in patient safety. This concept for investigator-driven research
was emulated by the National Patient Safety Foundation, which turned
to the Chair of this APSF Committee to establish its own research
program.
Of the safety research topics that have been supported by APSF
grants, those dealing with the development and use of patient simulation
for training, education, and research have had the most visible
impact. Indeed, the importance of simulation for safety improvement
and error reduction was specifically mentioned in the IOM report.
The essence of this activity, started with seed funding from the
APSF, has now spread around the world and to many other health care
applications well beyond anesthesiology. It is hard to imagine where
the initial funding for simulation research would have come from
if APSF had not been there to provide it. This experience suggests
that the patient safety research and the Patient Safety Centers
of Excellence called for in the IOM report should be implemented
in a way that encourages investigator-driven research as opposed
to relying on a program-driven RFP basis, since the former is more
likely to remain free of political influence.
APSF has had several other definite influences on safety in anesthesia,
but those noted above form the primary basis for the impact we have
achieved. One specific initiative, in which we were unable to make
headway, does deserve mention. Over the years, we have considered
seriously and repeatedly how to approach the idea of reporting and
analyzing critical events in anesthesiology. This is one of the
most difficult, controversial and important issues addressed in
the IOM report. It is from our study and deliberations on this sensitive
topic that we offer our opinions and, in some cases, challenge the
recommendations of the IOM report.
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