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KEY POINTS

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KEY POINTS

  1. The patient should be the focus of anesthesia care.

  2. The goal of anesthesia care must be to ensure that no patient is harmed.

  3. Preventing harm is challenging because care is complex and serious adverse events are relatively rare and often the result of many causes rather than a single one.

  4. Weaknesses in “the system” are often the source of serious adverse events that are sometimes attributed to clinical incompetence.

  5. Vigilance alone is not enough; a strategy of error prevention is required to prevent harm.

  6. Organizations, departments, and groups must use a top-down, integrated approach and a commitment to creating a safe environment and system for safety.

  7. Safety must be the first priority to create an organization that operates at the highest level of reliability.

  8. Anesthesia professionals must employ a broad array of safety tactics as a foundation for their anesthesia practice.

  9. Teamwork and communication among the perioperative caregivers are critical components of patient safety.

  10. High-quality, safe anesthesia practice also requires a proactive, forward-looking approach that identifies successes and disseminates their characteristics widely to ensure resilience in the system.

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INTRODUCTION

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Patients expect high quality and complete safety from their anesthesia providers. They fear the possibility of experiencing pain, awareness during surgery, and the potential for serious complications, including death.1,2 Patients are even apprehensive about what anesthesia providers consider as routine or “minor complications,” such as postoperative nausea and vomiting. Our empathy and our resolve to address these concerns are fundamental tenets for patient-centered care across the spectrum of anesthesia practice. Anesthesia providers develop a comfort with their craft, despite its inherent dangers. Over time, the administration of potentially lethal drugs, the management of apnea, and the control of altered physiologic systems become almost routine. With experience, these providers may even take for granted the inherently hazardous art and science of rendering patients insensible to pain, unconscious, and paralyzed. While meeting these patient needs demands knowledge, skills, and continuous vigilance from each individual practitioner, equally important is a system design that ensures safe practitioners; provides the appropriate drugs, technologies, policies, and procedures to foster safe practice; monitors performance of the entire process (including both outcomes and patient satisfaction); identifies safety and quality problems; and implements corrections. All of these rely on and contribute to a culture of safety and quality at all levels of the system—a culture that supports these needs not only in words but also in deeds and actions.

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In 2001, an Institute of Medicine (IOM) committee identified patient safety, quality of care, and patient-centered care (ie, individualized care) as progressively increasing levels of excellence in the overall health care process.3 This view is consistent with the tenets of other organizations that serve the public while dealing with potentially lethal outcomes (eg, the commercial aviation industry). In short, safety is the foundation on which quality (eg, the application of evidence-based approaches) and then patient-centeredness are ...

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