Anesthesiologists are recognized as the healthcare leaders in patient safety. The 1999 Institute of Medicine’s To Err Is Human report created the first national sense of urgency to address patient safety. It also noted the special case of anesthesiology in which the specialty took successful steps a full two decades earlier to dramatically improve patient safety.
The remarkable leadership of anesthesiologists continues to be highlighted. Now, two decades after the Institute of Medicine’s report, Still Not Safe, a book supported by the Robert Wood Johnson Foundation and released January 2020, describes how anesthesiology has singularly pursued a safety model that has supported research by both clinicians and safety scientists.
It is this model of incorporating safety scientists, along with focused attention to patient safety, that makes anesthesiology so unique in healthcare. Moreover, the book applauds the specialty for pulling together diverse groups from industry, professional societies, regulatory agencies, and healthcare to develop novel approaches for resolving patient safety issues and implementing them through collaborative actions.
The American Board of Anesthesiology (ABA) has played significant and heretofore underappreciated roles in promoting the anesthesia patient safety movement. The ABA has provided a fertile environment for progressive specialty leaders to debate how to best improve patient safety.
- Former ABA directors Arthur S. (Art) Keats, M.D. and William K. Hamilton, M.D. debated how to best study anesthesia errors and anesthesia-related deaths in dueling commentaries within Anesthesiology in 1979. These commentaries were triggered by the 1978 study of human factors on preventable anesthesia mishaps by Jeffrey B. Cooper, Ph.D. et al in the same journal. Cooper’s study was the first to suggest that there were human and systematic process factors that played a role in anesthesia-associated deaths and morbidity. The Cooper report and subsequent commentaries by Keats and Hamilton generated awareness of patient safety within the specialty and kindled a sense of urgency to better understand and improve patient safety.
- Former ABA director Richard J. (Dick) Kitz, M.D., who hired Dr. Cooper into the Bioengineering Unit in his Massachusetts General Hospital Department of Anesthesia and Critical Care, brought interested anesthesiologists from the U.S. and other countries together during late 1984 in Boston. Ellison C. (Jeep) Pierce, Jr., M.D., the American Society of Anesthesiologists (ASA) president at that time, teamed with Drs. Kitz, Cooper and John H. Eichhorn, M.D., after that collaborative meeting and developed the concept of a patient safety-oriented foundation that could address important issues quickly and nimbly and with targeted actions. The resulting foundation, the Anesthesia Patient Safety Foundation (APSF), has become one of the leading organizations worldwide in its advocacy for patient safety and support for multidisciplinary research on human factors and systematic process that can be improved to increase patient safety.
- The emergence of the APSF and the excitement associated with the ASA’s adoption of basic monitoring standards in the second half of the 1980s were discussed in depth in board meetings by ABA directors as they pressed to modify the expectations of board-certified anesthesiologists in the rapidly expanding specialty. The debates at the ABA board meetings included defining the role of board certification criteria, as well as the linked training requirements for anesthesia residency programs, in a new world in which anesthesiology was a leader in patient safety. In this environment, former ABA director Ephraim S. (Rick) Siker, M.D., played a leading role as he concomitantly served as the APSF’s founding secretary and, subsequently, became its first executive director.
- Former ABA director Robert K. (Bob) Stoelting, M.D., and I followed, and both of us later became APSF president. I currently serve as president of the APSF and current ABA Director Daniel J. Cole, M.D., is the APSF’s vice-president.
Improving patient safety remains an evolving, crucially important obligation of all anesthesiologists and other healthcare providers.
Anesthesiologists continue to lead the world of healthcare with our patient safety initiatives. Patient safety is a team effort, inclusive of all healthcare professionals, industry and regulatory agency partners, safety scientists, and innovators. We should all take pride in this leadership role as we work together towards the noble goal of continuously improving the safety of our patients.
What examples have you seen displayed of the leadership role anesthesiologists play in promoting patient safety?
About the Author
Mark Warner, M.D., is a professor of anesthesiology at the Mayo Clinic. In his institution, he has served as chair of the Department of Anesthesiology, the physician leader of its hospitals, executive dean of its College of Medicine and Science, and a member of its Board of Governors.
Dr. Warner has served in the leadership of several national anesthesiology organizations. He is a past president of the American Society of Anesthesiologists, the American Board of Anesthesiology, and the Academy of Anesthesiology. He currently serves as president of the Anesthesia Patient Safety Foundation.