Steven Greenberg, MD, Clinical Professor, Department of Anesthesiology and Critical Care, University of Chicago, and Vice Chairperson, Education, Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University HealthSystem, and Medical Director of Critical Care, Evanston Hospital.
Steven Greenberg, MD, Clinical Professor, Department of Anesthesiology and Critical Care, University of Chicago, and Vice Chairperson, Education, Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University HealthSystem, and Medical Director of Critical Care, Evanston Hospital.
Mark Warner, MD, President, APSF, and Annenberg Professor and former Chair of Anesthesiology, Mayo Clinic, Rochester.
Mark Warner, MD, President, APSF, and Annenberg Professor and former Chair of Anesthesiology, Mayo Clinic, Rochester.
We are delighted to announce the first-ever APSF column in the ASA Monitor. The column will appear in the ASA Monitor every other month starting in November 2020. It will highlight key topics related to perioperative patient safety and APSF's role in further advancing its vision “that no patient shall be harmed by anesthesia care.” We wish to extend our gratitude to the Monitor and its editor-in-chief, Steven Shafer, MD, for this important collaboration and opportunity to further inform its readership about perioperative patient safety and the integral role that anesthesia professionals play in it.
This year marks the 35th anniversary of the APSF, the first patient safety multiprofessional organization in the United States. In 1985, the APSF established its goals that are still at the core of its mission today (Anesth Analg 2012;114:791-800; Anesthesia Patient Safety Foundation Mission and Vision Statements 2020):
Sponsor research that facilitates a clearer understanding of preventable anesthetic injuries
Encourage educational programs that may aid in reducing preventable anesthetic injuries
Promote national and international dialogue and exchange of ideas with regard to the causes and prevention of anesthetic-related adverse events
Establish an APSF Newsletter to be given to all anesthesia professionals free of charge that informs them of anesthesia patient safety-related topics
The APSF Newsletter, the primary vehicle by which the organization disseminates safety information, is now also celebrating its 35th anniversary. As part of the celebration, the APSF editorial board voted on the 10 most impactful articles published in it over these 35 years. The board then invited expert safety authors to editorialize “What Then?” and “What Now?” about each article. This inaugural APSF article in the Monitor will highlight the most salient messages captured in these “top 10” articles.
Top Articles from 1985-2000
ASA Adopts Basic Monitoring Standards J.H. Eichhorn. Spring 1987.
Eichhorn's pioneering work with monitoring standards at Harvard University served as the roadmap for the adoption and implementation of ASA's first practice parameter. A subsequent review by Dr. Eichhorn suggested a greater than five-fold reduction in severe adverse events after adoption of the standards (Problems in Anesthesia 2001;13:430-443).
From the Literature: ECRI Review Explains, Warns of OR Fires C.H. Lake. Winter 1991.
Early in the 1990s, the Emergency Care Research Institute warned health care professionals about the danger of OR fires and the associated causes (fuels, oxidizers, and igniters) (APSF Newsletter 2020;35:82-84). Lake and colleagues detailed the APSF's efforts, which included developing a safety algorithm and fire safety video to serve as cognitive aids for all health care professionals to reduce this disastrous, preventable event. Data from the Pennsylvania Patient Safety Authority suggested a decline in surgical fires (Surgical Fires: Decreasing Incidence Relies on Continued Prevention Efforts).
Induced Hypotension Tied to Possible Vision Impairments A.S. Lofsky, M. Gorney. Summer 1998.
The APSF alerted health care professionals in 1998 of an apparent increase in patients with postoperative visual loss (POVL) after undergoing spine surgery in a prone position (APSF Newsletter 1998; 13). Health care professional awareness coupled with collaborative work from the ASA, APSF, and other national organizations led to a 2.7-fold decline in the incidence of ION from 1998 to 2012 (Anesthesiology 2016;125:457-64).
Top Articles from 2001-2010
Special Issue: Production Pressure – Does the Pressure to Do
More, Faster, with Less, Endanger Patients? R.C. Morell, R.C. Prielipp. Spring 2001.
The deleterious effects of production pressure on patient safety had been a focus of the APSF for two decades. Three main issues can contribute to the negative impact of production pressure on patient safety: normalization of deviance, professional burnout, and lack of education/training (APSF Newsletter 2020;35:87-89).
Beach Chair Position May Decrease Cerebral Perfusion D.J. Cullen, R.R. Kirby. Summer 2007.
This original report provided four cases in the beach chair position that resulted in serious neurologic adverse events. The projected cause was low cerebral perfusion associated with intraoperative maintenance of low mean arterial pressures at the level of the head. Current evidence suggested that anesthesia professionals should consider the hydrostatic gradients and actively maintain patient blood pressure as close to baseline as possible (APSF Newsletter 2020;35:90-92).
Top Articles from 2011-2020
Managing Cardiovascular Implantable Electronic Devices (CIEDs) During Perioperative Care J.P. Neelankavil, A.Thompson, A. Mahajan. Fall 2013.
Neelankavil et al. have summarized the importance of the original 2011 ASA consensus statement on the perioperative management of CIEDs to patient safety and the subsequent 2020 ASA practice advisory on this topic (Anesthesiology 2020;132:225-52). The authors highlighted new technologies that have been developed that anesthesia professionals need to continue to understand to maintain safe perioperative care in patients with CIEDs.
Monitoring of Neuromuscular Blockade: What Would You Expect if You Were the Patient? R.K. Stoelting. February 2016.
In this editorial, Stoelting emphasized the importance of monitoring for residual neuromuscular blockade. Murphy has summarized past and current data as it relates to this important patient safety issue. He suggests that recent literature supports a reduction in adverse events when neuromuscular blockade reversal is routinely used (APSF Newsletter 2020;35:94-5).
National Partnership for Maternal Safety – Maternal Safety Bundles J.M. Banayan, B.M. Scavone. October 2016.
Since the initiation of the national maternal safety bundle campaign, U.S. maternal mortality has increased. The authors now explain why the initiation of bundles has not yet resulted in a reduction in mortality and provide an update on the addition of other bundles that may help to reduce U.S. maternal adverse events (APSF Newsletter 2020;35:96-7).
The Effect of General Anesthesia on the Developing Brain L.S. Janik. October 2016.
There are three large studies (PANDA, MASK, and GAS) that provide reassurance to parents and providers that a single exposure to general anesthesia in children does not cause adverse neurodevelopmental outcomes (APSF Newsletter 2020;35:102-3). However, further research is required to determine the safety of multiple anesthetics on children.
Perioperative Brain Health – It's Not All Positive Attitude, Exercise, and Superfoods N Kamdar, LA Fleisher, DJ Cole. February 2019.
The article describes the ASA's Perioperative Brain Health Initiative, the necessary measures that are being taken, and the potential research opportunities available to prevent postoperative cognitive dysfunction after anesthesia (APSF Newsletter 2020;35:104-106).
We hope that the ASA Monitor readership will remain engaged with APSF's initiatives to ensure perioperative patient safety. Further articles in the APSF column will focus on the organization's current 12 patient safety initiatives (Table).
The authors have no conflicts to declare other than their associations with the APSF.
