The concept of providing a safe clinical environment centered on the patient is not a new concept in the field of anesthesiology. In fact, the profession was the first medical specialty to both identify and embrace the concept of patient safety as a central tenant of its clinical and research mission. The terms “patient safety,” “patient safety movement,” and “no patient shall be harmed” all came from the founding moments that led, in 1985, to the establishment of the first specialty-specific organization dedicated to patient safety, the Anesthesia Patient Safety Foundation (APSF). This organization has been the model on which all subsequent efforts to improve patient safety throughout organized medicine have been based, including the establishment of the National Patient Safety Foundation in 1997. Anesthesiology’s proximal role in patient safety was lauded by the Institute of Medicine’s Quality of Care in America Committee, which published To Err Is Human: Building a Safer Health System in 1999, which singled out the work the specialty had performed, demonstrating a commitment to patient safety as the model for all other specialties to emulate. Today, patient safety is arguably the strongest driving force in medicine besides cost, and serves as the preeminent metric by which we measure clinical outcomes.
Originally, patient safety in anesthesia arose, in part, to address concerns raised in the lay press concerning hypoxic-mediated morbidity and mortality in the early 1980s. Efforts led by Dr. Ellison “Jeep” Pierce, former president of the ASA and Chair of the Department of Anesthesia at the New England Deaconess Hospital, and others in the Harvard consortium of hospitals resulted in identifying anesthesia accidents and malpractice costs as having a common solution, which was to make the practice of anesthesia safer. These early efforts resulted in the formation of the ASA Committee on Patient Safety and Risk Management, and with it several innovations. First, monitoring standards were identified and mandated to promote technical solutions to provide safer care, such as the use of pulse oximetry and real-time analysis of end-tidal gas concentrations to address the dangerous conditions of unrecognized/inadvertent esophageal intubation/intraoperative loss of adequate ventilation. Second, the nascent field of human factor engineering began to be adapted by the practice of anesthesia by incorporating critical incident analysis from other professions, mainly aviation safety. Together, these efforts resulted, along with issues raised by an international symposium on Preventable Anesthesia Mortality and Morbidity in 1984, in the formation of the APSF.
In the current era, the focus on anesthesia patient safety has led to a number of important safety initiatives and has helped in identifying clinical areas of risk. At the same time, ASA, the APSF, individual anesthesiologists, and the newly formed Anesthesia Quality Institute (AQI) have worked in concert with other patient safety organizations to promote safety initiatives across spectrums of patient care, especially in the OR environment. Some of these include: