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 (after two patients developed paraplegia following administration of spinal anesthetics), Drs Robert Dripps and Leroy Vandam helped prevent this technique from being abandoned in North America by carefully reporting outcomes of 10,098 patients who received spinal anesthesia. 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, perhaps the first clinical outcomes study to be performed (long before the term outcomes research gained widespread use), demonstrated 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, anesthesiologists were recognized for being the first medical specialists 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 could practice. The effort resulted in standards for basic monitoring during general anesthesia that included detection of carbon dioxide in exhaled gas. Adoption of these standards was associated with a reduction in the number of patients suffering brain damage or death secondary to ventilation mishaps during general anesthesia. A fortunate associated result was that the cost of medical liability insurance coverage also declined.
In 1984, Ellison Pierce, president of the ASA, created its Patient Safety and Risk Management Committee. The Anesthesia Patient Safety Foundation (APSF), which celebrated its 25th anniversary in 2011, was also Dr Pierce’s creation. The APSF continues ...