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  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. Serious adverse events are usually the result of weaknesses in the "system" of anesthesia care, not the fault of incompetent clinicians.

  5. To prevent adverse events, a strategy is needed, not simply vigilance.

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

  7. Safety must be the number 1 priority to create an organization that operates at the highest level of reliability.

  8. Anesthesia professionals must employ a broad array of safety tactics.

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

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, they may even take for granted the inherently hazardous art and science of rendering patients insensible to pain, unconscious, and paralyzed. Yet patients do not take anesthesia for granted. To the contrary, they fear the possibility of experiencing pain or awareness, as well as the potential for death or other serious complications.1,2 They also fear what professionals might consider "minor complications"; patients often view postoperative nausea and vomiting as dreaded and prominent complications associated with the procedure.

This chapter focuses on patient safety and quality and is based on the principle that the patient is the center of care. The person or team performing the procedure will have medical requirements that are embedded in the anesthetic plan, but the patient's concerns, fears, values, and expectations also must be addressed. Although that may seem obvious, historically, the design of health care systems, including anesthesia care, has been centered on the needs and convenience of the providers and the facility. The underlying concept was that quality of care alone was enough, whereas quality of service (ie, "patient centeredness") was relatively insignificant in the process. That concept is changing, and this chapter begins by emphasizing that patient perceptions must be considered in the design of a safe, high-quality anesthetic experience.

The patient's most fundamental needs are for high quality and complete safety. Meeting these expectations demands knowledge, skills, and continuous vigilance. Equally important is a system 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 demand a culture of safety and quality at all levels of the system, a culture that supports these needs not just in words but in deeds and actions.

In 2001, ...

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