In the 1980s, anesthesiology was recognized as the first medical specialty to adopt mandatory safety-related clinical practice guidelines. Adoption of these guidelines, describing standards for basic monitoring during general anesthesia, was associated with a reduction in the number of patients suffering brain damage or death secondary to ventilation mishaps during general anesthesia.
In 1999 the Institute of Medicine of the (U.S.) National Academy of Sciences summarized available safety information in its report, To Err Is Human: Building a Safer Healthcare System, which highlighted many opportunities for improved quality and safety.
It has long been recognized that quality and safety are closely related to consistency and reduction in practice variation.
In manufacturing and in medicine, there is a natural tendency to assume that errors can be prevented by better education or better management of individual workers (ie, to look at errors as individual failures made by individual workers rather than as failures of a system or a process). To reduce errors, one changes the system or process to reduce unwanted variation so that random errors are less likely.
As a profession, anesthesiology has spearheaded efforts to improve patient safety. Some of the first studies to evaluate safety of care focused on provision and sequelae of anesthesia. When spinal anesthesia was virtually abandoned in the United Kingdom (as a response to two patients developing subsequent paraplegia), Drs Robert Dripps and Leroy Vandam helped prevent spinal anesthesia from being abandoned in North America by carefully reporting outcomes of 10,098 patients who received this technique. They determined that only one patient (who proved to have a previously undiagnosed spinal meningioma) developed severe, long-term neurological sequelae.
After halothane was introduced into clinical practice in 1954, concerns arose about whether it might be associated with an increased risk of hepatic injury. The National Halothane Study, a very early clinical outcomes study, was performed (long before the term outcomes research gained widespread use), demonstrating the remarkable safety of the then relatively new agent compared with the alternatives. It failed, however, to settle the question of whether “halothane hepatitis” actually existed.
In the 1980s, anesthesiology was recognized as the first medical specialty to adopt mandatory safety-related clinical practice guidelines. Adoption of these guidelines was not without controversy, given that for the first time the American Society of Anesthesiologists (ASA) was “dictating” how physicians should practice. Adoption of standards for basic monitoring during general anesthesia (that included detection of carbon dioxide in exhaled gas) was associated with a reduction in the number of patients suffering brain damage or death secondary to ventilation mishaps. A fortunate associated result was that the cost of medical liability insurance coverage for American anesthesiologists also declined.
In 1984, Dr Ellison Pierce, president of the ASA, created its Patient Safety and Risk Management Committee. The Anesthesia Patient Safety Foundation (APSF), which celebrated ...