APSF Comments on Specific Recommendations in
the IOM Report
Robert K. Stoelting, M.D., President, APSF
What safety issues and concerns remain
in anesthesia practice and how is APSF going about addressing them?
It must be said that safety is a never-ending quest, particularly
as efforts are made to control and then reduce the costs of health
care. Almost every action in the spirit of reducing costs has some
potential to create new unsafe conditions. Almost every new treatment
and technology introduced to improve diagnosis and treatment of
disease or improvement of the delivery system introduces new opportunity
for error and system failure. The motto of the American Society
of Anesthesiologists is "Vigilance." Safety requires that
all health care professions exercise vigilance in everything they
do and in every change that they make to ensure safety for their
patients.
APSF has recently set its sights on a burgeoning concern about
the safety of office-based procedures, particularly those in which
anesthesia is administered. We see that moving complex procedures
into office settings can be a clear and present threat to patient
safety due to factors such as the lack of training of personnel,
the absence of adequate monitoring and anesthesia delivery equipment,
poorly constructed facilities, and the overall lack of accreditation,
credentialing, regulation and oversight of activities in the physician
office. We are embarking on several fronts to address these concerns
and hope that those who will take a leadership role in the Federal
and State governments will support those efforts. Beyond this, we
will continue in our successful means of communications and research
to identify issues large and small that threaten safety in anesthesia.
We see the development of systems for incident reporting, data gathering,
and event analysis as a fundamental need. One approach we plan to
study is the feasibility of providing for anesthesia settings the
equivalent of the aviation "black box" (flight data recorder)
that has been so instrumental to the success of aviation safety
over the past several decades. The technology to enable this function
is now available, but collaboration between manufacturers, users
and other stakeholders is needed to create a workable and effective
system. APSF will work as it has in the past to create the dialogue
and leadership that is needed.
