Evolution of Anesthesia Patient Safety Movement: Reply

We thank Dr. Brown for his insights regarding the integration of nascent quality of care methodologies and initiatives into the American College of Anesthesiologists in the 1960s (both organizations were located in Park Ridge, Illinois, in the 1960s and currently are located in Schaumburg, Illinois).¹  We had not included that information in our review of the evolution of the anesthesia patient safety movement.²  As he appropriately notes, the development of quality of care activities provided a crucial contribution to the onset of the anesthesia patient safety movement in the 1980s. Drs. Brown, Siker, and others played important leadership roles in both organizations and advocated for the quality of care activities that would subsequently serve as the foundation of the movement. They appropriately should be credited for their diligent efforts to improve quality of care in anesthesiology.

The link between anesthesiology and patient safety arguably goes back to the death of 15-year-old Hannah Greer on January 28, 1848, during a chloroform anesthetic.³  One hundred years ago, in its inaugural issue, Current Researches in Anesthesia & Analgesia (subsequently named Anesthesia & Analgesia) published an anesthesia patient safety article, “Morbidity and Mortality in Obstetrics as Influenced by Anesthesia.”⁴  Numerous studies on anesthesia-related mortality and morbidity followed. In 1978 through the 1980s, Jeffrey B. Cooper, Ph.D., John H. Eichhorn, M.D., and colleagues introduced the concepts of standards of patient monitoring and the study of human factors and critical incidents in analyses of anesthesia errors and mishaps.^5–8  These concepts provided the specialty with new opportunities to improve patient safety.

This progression of new knowledge and approaches to patient safety, coupled with the preexisting organizational advocacy for quality of care described, in part, by Dr. Brown, provided the basis for the specialty to be able to respond to the swell in public interest in anesthesia patient safety that arose from the 1982 ABC television network’s 20/20 production “The Deep Sleep: 6,000 Will Die or Suffer Brain Damage”⁹  and to a concomitant growing medical malpractice insurance crisis for anesthesiologists in the United States. It was these unique challenges, in our opinion, that led to a sharp demarcation in 1982 between the previous steady but slowly progressive efforts to improve quality of care and the new tsunami of interest in rapidly developing and implementing a distinct anesthesia patient safety movement. Therefore, it is this period starting in 1982 that we designated for the purposes of our article as the start of the anesthesia patient safety movement.

The authors declare no competing interests.