The most feared medical specialty? It’s actually one of the safest.
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
But should patients worry? Physician anesthesiologists suffered a crisis in confidence in 1982 when the ABC television program 20/20 aired, “The Deep Sleep: 6,000 Will Die or Suffer Brain Damage,” about anesthesia complications, brain injury, and death. At that time, physician anesthesiologists were having difficulty obtaining malpractice insurance because, although anesthesia claims were not the most frequent, they were the most costly due to outcomes associated with medical errors. Very often the error was an unrecognized esophageal intubation, where the breathing tube was putting oxygen in the stomach instead of the lungs. Estimates of mortality caused solely by anesthesia care ranged from 1 to 12 per 10,000.
At that time, ASA First Vice President Ellison C. “Jeep” Pierce, M.D., looked at the crisis and had a choice: fight for tort reform so insurance payouts and malpractice insurance costs would be decreased, making malpractice insurance more widely available, or increase the safety of anesthesia . Dr. Pierce decided to establish a new ASA committee, the Committee on Patient Safety and Risk Management, which was the first time “patient safety” was used in this context. Additionally, ASA, under his leadership, formed the Anesthesia Patient Safety Foundation (APSF) and started a Closed Claims project. Dr. Pierce was “on a perpetual mission to prevent patients from being injured or killed by anesthesia care.” The APSF was the first organization formed specifically to improve patient safety. Since that time, the organization has funded and rewarded research and publishes a newsletter that continues to incentivize advances in patient safety. The Closed Claims project collected malpractice cases to discern causes of anesthesia accidents and prevent them.
This increase in patient safety was not created through the touch of a magic wand. It was completed through the well-defined process that we call Plan Do Study Act (PDSA) cycles. It was a man with a vision, an organization dedicated to saving lives, sharing ideas and research, and insisting on excellence and persistence. Many small steps led to the recognition of anesthesia as a leading specialty in patient safety in the 1999 landmark publication To Err is Human. In fact, anesthesia is arguably the safest medical specialty today. We are the closest to Six Sigma-level safety, which means that 99.99966 percent of the time in a process, no defects are created. This method of measuring quality was developed in the manufacturing sector, and it is the level of quality expected in the airline and nuclear industries.
Susan G. Curling is an anesthesiologist and member, ASA Committee on Communications.
Reposted from Kevin, M.D.
A footnote from Pat Lynch – I placed this here because the same holds true for the maintenance of anesthesia equipment. It is among the easiest of medical equipment to maintain, provided you follow the procedures and post-checkout procedures to the letter. All hospitals should be servicing their own anesthesia machines.